Healthcare Provider Details

I. General information

NPI: 1780717132
Provider Name (Legal Business Name): BAO DUC NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: BAO DUC NGUYEN D.C., P.A.

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 03/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8637 FREDERICKSBURG RD STE. #149
SAN ANTONIO TX
78240-1283
US

IV. Provider business mailing address

8637 FREDERICKSBURG RD STE. #149
SAN ANTONIO TX
78240-1283
US

V. Phone/Fax

Practice location:
  • Phone: 210-828-3737
  • Fax: 210-614-5773
Mailing address:
  • Phone: 210-828-3737
  • Fax: 210-614-5773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number10288
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: