Provider Demographics
NPI:1730376575
Name:PHAM AND NONG PROFESSIONAL CHIROPRACTIC CORPORATION
Entity type:Organization
Organization Name:PHAM AND NONG PROFESSIONAL CHIROPRACTIC CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TRUC
Authorized Official - Middle Name:NGOC
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:408-947-8684
Mailing Address - Street 1:639 TULLY RD STE G
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95111-1000
Mailing Address - Country:US
Mailing Address - Phone:408-947-8684
Mailing Address - Fax:408-947-0321
Practice Address - Street 1:639 TULLY RD STE G
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95111-1000
Practice Address - Country:US
Practice Address - Phone:408-947-8684
Practice Address - Fax:408-947-0321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26797111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0267970Medicare PIN
CAU82638Medicare UPIN