Healthcare Provider Details

I. General information

NPI: 1396242582
Provider Name (Legal Business Name): TRITAN NGUYEN CHIROPRACTIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 04/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18805 COX AVE STE 170
SARATOGA CA
95070-4162
US

IV. Provider business mailing address

18805 COX AVE STE 170
SARATOGA CA
95070-4162
US

V. Phone/Fax

Practice location:
  • Phone: 408-364-6600
  • Fax: 408-364-2041
Mailing address:
  • Phone: 408-364-6600
  • Fax: 408-364-2041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC32378
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC32378
License Number StateCA

VIII. Authorized Official

Name: DR. TAN TRI NGUYEN
Title or Position: EXECUTIVE
Credential: DC
Phone: 408-832-8221