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General NPI Number Information
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NPI Number | 1255724951
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Entity Type | Organization
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Legal Business Name | PRIMARY CARE CHIROPRACTIC CLINIC, P.A.
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Dates
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Enumeration Date | 03/05/2015
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Last Update Date | 03/05/2015
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Provider Practice Location Address
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Address Line | 162 PENNSYLVANIA AVE W SUITE C
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City | SAINT PAUL
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State | MN
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Zip | 55103-1893
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Country | US
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Telephone | 651-288-7188
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Fax | 651-288-9588
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Provider Business Mailing Address
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Address Line | 162 PENNSYLVANIA AVE W SUITE C
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City | SAINT PAUL
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State | MN
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Zip | 55103-1893
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Country | US
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Telephone | 651-288-7188
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Fax | 651-228-9588
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Authorized Official
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Title or Position | OWNER
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Name | DR. TCHUNENG VU
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Credential | D.C.
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Telephone | 651-288-7188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 4662
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License Number State | MN
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