MEDICARE: LOAN PHAM VAN 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	16057	TX

General Provider Information

NPI Number	:	1811736523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOAN PHAM VAN DC

Provider Business Mailing Address
First Line	:	5609 SW GREEN OAKS BLVD STE 102
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-1153
Country	:	US
Telephone Number	:	817-765-2004
Fax Number	:

Provider Business Practice Location Address
First Line	:	5609 SW GREEN OAKS BLVD STE 102
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-1153
Country	:	US
Telephone Number	:	817-765-2004
Fax Number	:

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

Provider Enumeration Date	:	05/22/2024
Last Update Date	:	12/04/2025

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Directions to “ LOAN PHAM VAN DC” Practice Location

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