MEDICARE: DR. ANH V NGUYEN D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC007839L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2194991000	OTHER	PA	KEYSTONE HEALTH PLAN EAST
2	30019331	OTHER	PA	KEYSTONE MERCY HEALTH
3	1506770	OTHER	PA	INDEPENDENCE BLUE CROSS

General Provider Information

NPI Number	:	1194767939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANH V NGUYEN D.C.

Provider Business Mailing Address
First Line	:	5416 N 5TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19120-2802
Country	:	US
Telephone Number	:	215-324-1400
Fax Number	:	215-324-1400

Provider Business Practice Location Address
First Line	:	5416 N 5TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19120-2802
Country	:	US
Telephone Number	:	215-324-1400
Fax Number	:	215-324-1400

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	07/09/2007

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