MEDICARE: DIEM T. NGUYEN, DC A PROFESSION CHIROPRACTIC CORPORATION

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	DC0277100	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366560658
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIEM T. NGUYEN, DC A PROFESSION CHIROPRACTIC CORPORATION

Provider Business Mailing Address
First Line	:	7811 LAGUNA BLVD STE 180
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95758-7949
Country	:	US
Telephone Number	:	916-478-2634
Fax Number	:	916-478-2563

Provider Business Practice Location Address
First Line	:	7811 LAGUNA BLVD STE 180
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95758-7949
Country	:	US
Telephone Number	:	916-478-2634
Fax Number	:	916-478-2563

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DIEM T NGUYEN
Credential	:	DC
Telephone Number	:	916-478-2634

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	08/22/2020

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