=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922296177
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOSEPH CHAU BAO NGUYEN, CHIROPRACTIC, CORP.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2007
-----------------------------------------------------
Last Update Date | 10/11/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2901 W MACARTHUR BLVD STE. 105
-----------------------------------------------------
City | SANTA ANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92704-6910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-210-2340
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2901 W MACARTHUR BLVD STE. 105
-----------------------------------------------------
City | SANTA ANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92704-6910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-210-2340
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR OF CHIROPRACTIC
-----------------------------------------------------
Name | JOSEPH CHAU BAO NGUYEN
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 714-210-2340
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | DC27689
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------