MEDICARE: DR. VAN A NGUYEN DC

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		IL

General Provider Information

NPI Number	:	1346256344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VAN A NGUYEN DC

Provider Business Mailing Address
First Line	:	2005 BLOOMINGDALE RD
Second Line	:	UNIT C
City	:	GLENDALE HTS
State	:	IL
Zip	:	60139-2151
Country	:	US
Telephone Number	:	630-893-1260
Fax Number	:	630-893-1261

Provider Business Practice Location Address
First Line	:	2005 BLOOMINGDALE RD
Second Line	:	UNIT C
City	:	GLENDALE HTS
State	:	IL
Zip	:	60139-2151
Country	:	US
Telephone Number	:	630-893-1260
Fax Number	:	630-893-1261

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	07/08/2007

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