MEDICARE: BAO DUC NGUYEN

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	10288	TX

General Provider Information

NPI Number	:	1780717132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BAO DUC NGUYEN

Provider Business Mailing Address
First Line	:	8637 FREDERICKSBURG RD
Second Line	:	STE. #149
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-1283
Country	:	US
Telephone Number	:	210-828-3737
Fax Number	:	210-614-5773

Provider Business Practice Location Address
First Line	:	8637 FREDERICKSBURG RD
Second Line	:	STE. #149
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-1283
Country	:	US
Telephone Number	:	210-828-3737
Fax Number	:	210-614-5773

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

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	03/12/2008

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Directions to “ BAO DUC NGUYEN ” Practice Location

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