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General NPI Number Information
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NPI Number | 1740342757
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Entity Type | Individual
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Provider Name | THONGLA POUNGTHANA DC
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Gender | Male
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1945 DECKER BLVD STE 12
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City | COLUMBIA
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State | SC
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Zip | 29206-3425
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Country | US
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Telephone | 803-782-9596
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Fax | 803-782-9505
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Provider Business Mailing Address
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Address Line | 105 OLD FIELD CT
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City | LEXINGTON
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State | SC
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Zip | 29072-2797
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Country | US
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Telephone | 803-808-9588
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Fax | 803-782-9505
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2421
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License Number State | SC
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