Provider Demographics
NPI:1992767313
Name:PHAM, CHUONG VAN (DC)
Entity type:Individual
Prefix:
First Name:CHUONG
Middle Name:VAN
Last Name:PHAM
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 1:5763 FALL CREEK CT
Mailing Address - Street 2:
Mailing Address - City:HALTOM CITY
Mailing Address - State:TX
Mailing Address - Zip Code:76137-2676
Mailing Address - Country:US
Mailing Address - Phone:817-759-2777
Mailing Address - Fax:817-759-2779
Practice Address - Street 1:1916 N BEACH ST
Practice Address - Street 2:
Practice Address - City:HALTOM CITY
Practice Address - State:TX
Practice Address - Zip Code:76111-6703
Practice Address - Country:US
Practice Address - Phone:817-759-2777
Practice Address - Fax:817-759-2779
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9847111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor