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General NPI Number Information
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NPI Number | 1598067340
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Entity Type | Individual
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Provider Name | JAN VAN TRUONG D.C.
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Gender | Male
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Dates
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Enumeration Date | 11/30/2010
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Last Update Date | 03/03/2016
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Provider Practice Location Address
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Address Line | 1720A MEDICAL PARK DR 160B
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City | BILOXI
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State | MS
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Zip | 39532-2129
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Country | US
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Telephone | 228-206-5389
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Fax |
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Provider Business Mailing Address
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Address Line | 1547 PELICAN BAYOU DR
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City | BILOXI
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State | MS
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Zip | 39532-8082
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Country | US
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Telephone | 228-238-9158
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 1711
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1171
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License Number State | MS
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