Healthcare Provider Details

I. General information

NPI: 1891412136
Provider Name (Legal Business Name): TOMMY THANH NHAN PHAM DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2022
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3339 LOMBARDY LN APT 929
DALLAS TX
75220-3357
US

IV. Provider business mailing address

3339 LOMBARDY LN APT 929
DALLAS TX
75220-3357
US

V. Phone/Fax

Practice location:
  • Phone: 504-613-7574
  • Fax:
Mailing address:
  • Phone: 504-613-7574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number15325
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: