Provider Demographics
NPI:1982158838
Name:NGUYEN, DAVIS (DC)
Entity type:Individual
Prefix:DR
First Name:DAVIS
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 1:2504 SANTA CLARA AVE STE 1-2
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-3070
Mailing Address - Country:US
Mailing Address - Phone:415-623-9258
Mailing Address - Fax:510-426-8255
Practice Address - Street 1:2504 SANTA CLARA AVE
Practice Address - Street 2:1-2
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-3070
Practice Address - Country:US
Practice Address - Phone:415-623-9258
Practice Address - Fax:510-426-8255
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-09
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33663111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor