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General NPI Number Information
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NPI Number | 1043602170
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Entity Type | Organization
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Legal Business Name | TN CHIROPRACTIC CLINIC, LLC
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Dates
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Enumeration Date | 02/26/2015
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Last Update Date | 02/26/2015
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Provider Practice Location Address
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Address Line | 1848 OLD NORCROSS RD STE A400
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-2311
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Country | US
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Telephone | 678-205-5546
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Fax | 678-205-8440
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Provider Business Mailing Address
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Address Line | 1848 OLD NORCROSS RD STE A400
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-2311
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Country | US
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Telephone | 678-205-5546
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Fax | 678-205-8440
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | TRUONG QUANG NGUYEN
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Credential | D.C.
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Telephone | 678-900-7361
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHIR009221
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License Number State | GA
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