Healthcare Provider Details

I. General information

NPI: 1790966539
Provider Name (Legal Business Name): BENJAMIN NGUYEN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8515 EDNA AVE #280
LAS VEGAS NV
89117-4442
US

IV. Provider business mailing address

8963 W VIKING RD
LAS VEGAS NV
89147-6504
US

V. Phone/Fax

Practice location:
  • Phone: 702-405-8189
  • Fax:
Mailing address:
  • Phone: 702-873-8199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberB01214
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: