Provider Demographics
NPI:1962970525
Name:NGUYEN, TONY (DC)
Entity type:Individual
Prefix:DR
First Name:TONY
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:576 FRANCIS PL SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-4108
Mailing Address - Country:US
Mailing Address - Phone:770-778-3948
Mailing Address - Fax:
Practice Address - Street 1:2253 NORTHWEST PKWY SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8764
Practice Address - Country:US
Practice Address - Phone:678-647-8692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-12
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010144111NI0013X, 111NI0900X, 111NN0400X, 111NN1001X, 111NP0017X, 111NR0200X, 111NR0400X, 111NS0005X, 111NT0100X, 111NX0100X, 111NX0800X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
No111NI0900XChiropractic ProvidersChiropractorInternist
No111NN0400XChiropractic ProvidersChiropractorNeurology
No111NN1001XChiropractic ProvidersChiropractorNutrition
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor
No111NR0200XChiropractic ProvidersChiropractorRadiology
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NT0100XChiropractic ProvidersChiropractorThermography
No111NX0100XChiropractic ProvidersChiropractorOccupational Health
No111NX0800XChiropractic ProvidersChiropractorOrthopedic