Healthcare Provider Details

I. General information

NPI: 1437298098
Provider Name (Legal Business Name): TAN M VUONG D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7829 N PERSHING AVE
STOCKTON CA
95207-1749
US

IV. Provider business mailing address

7829 N PERSHING AVE
STOCKTON CA
95207-1749
US

V. Phone/Fax

Practice location:
  • Phone: 209-951-7522
  • Fax: 209-951-8289
Mailing address:
  • Phone: 209-951-7522
  • Fax: 209-951-8289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC27301
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: