Healthcare Provider Details

I. General information

NPI: 1164696068
Provider Name (Legal Business Name): MAI NGUYEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 DENTON HWY SUITE 130
WATAUGA TX
76148-2541
US

IV. Provider business mailing address

6600 DENTON HWY SUITE 130
WATAUGA TX
76148-2541
US

V. Phone/Fax

Practice location:
  • Phone: 817-281-1700
  • Fax: 817-281-1773
Mailing address:
  • Phone: 817-281-1700
  • Fax: 817-281-1773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number9324
License Number StateTX

VIII. Authorized Official

Name: DR. THIEN NGUYEN
Title or Position: CHIROPRACTOR
Credential:
Phone: 817-281-1700