Provider Demographics
NPI:1811736523
Name:VAN, LOAN PHAM (DC)
Entity type:Individual
Prefix:
First Name:LOAN
Middle Name:PHAM
Last Name:VAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:LO
Other - Middle Name:PHAM
Other - Last Name:VAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:5609 SW GREEN OAKS BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-1153
Mailing Address - Country:US
Mailing Address - Phone:817-765-2004
Mailing Address - Fax:
Practice Address - Street 1:5609 SW GREEN OAKS BLVD STE 102
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-1153
Practice Address - Country:US
Practice Address - Phone:817-765-2004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-22
Last Update Date:2025-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16057111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor