=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962530295
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AI DUY NGUYEN PROFESSIONAL CHIROPRACTIC CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12526 WESTMINSTER AVE
-----------------------------------------------------
City | GARDEN GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92843
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-554-1111
-----------------------------------------------------
Fax | 714-554-7777
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12526 WESTMINSTER AVE
-----------------------------------------------------
City | SANTA ANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92706-2166
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-554-1111
-----------------------------------------------------
Fax | 714-554-7777
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. AI DUY NGUYEN
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 714-554-1111
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC18151
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------