Provider Demographics
NPI:1144968363
Name:PHAN, THU DIEM-NGUYEN (DC)
Entity type:Individual
Prefix:
First Name:THU
Middle Name:DIEM-NGUYEN
Last Name:PHAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 N CENTRAL EXPY STE 310
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-2046
Mailing Address - Country:US
Mailing Address - Phone:214-484-3236
Mailing Address - Fax:214-730-0948
Practice Address - Street 1:2929 N CENTRAL EXPY STE 310
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-2046
Practice Address - Country:US
Practice Address - Phone:214-484-3236
Practice Address - Fax:214-730-0948
Is Sole Proprietor?:No
Enumeration Date:2022-05-26
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15062111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor