MEDICARE: TRIET MINH PHAM DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH14974	FL

General Provider Information

NPI Number	:	1568250850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRIET MINH PHAM DC

Provider Business Mailing Address
First Line	:	106 W NORTH BLVD STE 102
Second Line	:
City	:	LEESBURG
State	:	FL
Zip	:	34748-5039
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 W NORTH BLVD STE 102
Second Line	:
City	:	LEESBURG
State	:	FL
Zip	:	34748-5039
Country	:	US
Telephone Number	:	352-702-4275
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2025
Last Update Date	:	01/06/2026

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Directions to “ TRIET MINH PHAM DC” Practice Location

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