Healthcare Provider Details

I. General information

NPI: 1043493745
Provider Name (Legal Business Name): ANTHONY QUANG NGUYEN CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2007
Last Update Date: 07/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 SOUTH B STREET SUITE B
SAN MATEO CA
94401-4119
US

IV. Provider business mailing address

517 S B ST STE B
SAN MATEO CA
94401-4119
US

V. Phone/Fax

Practice location:
  • Phone: 650-343-4600
  • Fax: 650-342-2643
Mailing address:
  • Phone: 650-343-4600
  • Fax: 650-342-2643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License NumberDC29171
License Number StateCA

VIII. Authorized Official

Name: DR. ANTHONY QUANG NGUYEN
Title or Position: CHIROPRACTOR OWNER
Credential: DC
Phone: 650-343-4600