Provider Demographics
NPI:1780717132
Name:NGUYEN, BAO DUC
Entity type:Individual
Prefix:
First Name:BAO
Middle Name:DUC
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:BAO
Other - Middle Name:DUC
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC, PA
Mailing Address - Street 1:8637 FREDERICKSBURG RD
Mailing Address - Street 2:STE. #149
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1283
Mailing Address - Country:US
Mailing Address - Phone:210-828-3737
Mailing Address - Fax:210-614-5773
Practice Address - Street 1:8637 FREDERICKSBURG RD
Practice Address - Street 2:STE. #149
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1283
Practice Address - Country:US
Practice Address - Phone:210-828-3737
Practice Address - Fax:210-614-5773
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10288111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor