Provider Demographics
NPI:1992874424
Name:VANG, BLONG BLIAXA (DC)
Entity type:Individual
Prefix:DR
First Name:BLONG
Middle Name:BLIAXA
Last Name:VANG
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 1:393 DUNLAP ST N STE 302
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-4207
Mailing Address - Country:US
Mailing Address - Phone:651-210-9657
Mailing Address - Fax:651-493-4682
Practice Address - Street 1:393 DUNLAP ST N STE 302
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4207
Practice Address - Country:US
Practice Address - Phone:651-210-9657
Practice Address - Fax:651-493-4682
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4471111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic