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General NPI Number Information
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NPI Number | 1205595550
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Entity Type | Organization
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Legal Business Name | NGUYEN SPINE AND SPORT CHIROPRACTIC
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Dates
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Enumeration Date | 12/14/2021
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Last Update Date | 12/30/2021
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Provider Practice Location Address
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Address Line | 2504 SANTA CLARA AVE STE 1-2
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City | ALAMEDA
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State | CA
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Zip | 94501-3074
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Country | US
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Telephone | 415-623-9258
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Fax | 510-426-8256
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Provider Business Mailing Address
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Address Line | 2504 SANTA CLARA AVE STE 1-2
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City | ALAMEDA
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State | CA
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Zip | 94501-3074
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Country | US
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Telephone | 415-623-9258
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. DAVIS NGUYEN
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Credential | DC
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Telephone | 415-623-9258
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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 |
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License Number State |
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