=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164430914
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NGUYEN CHIROPRACTIC, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2006
-----------------------------------------------------
Last Update Date | 08/24/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1720 VETERANS MEMORIAL DR.
-----------------------------------------------------
City | ABBEVILLE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-898-2225
-----------------------------------------------------
Fax | 337-893-0253
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1720 VETERANS MEMORIAL DR.
-----------------------------------------------------
City | ABBEVILLE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-898-2225
-----------------------------------------------------
Fax | 337-893-0253
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. TUAN-ANH NGUYEN DEREK NGUYEN
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 337-898-2225
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------