MEDICARE: DR. HOAN-VU QUANG 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	3534	WI

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
2	3534	OTHER	WI	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1780782730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HOAN-VU QUANG NGUYEN D.C.

Provider Business Mailing Address
First Line	:	163 E NORTH WATER ST
Second Line	:
City	:	NEENAH
State	:	WI
Zip	:	54956-2708
Country	:	US
Telephone Number	:	920-486-4031
Fax Number	:	920-725-2909

Provider Business Practice Location Address
First Line	:	163 E NORTH WATER ST
Second Line	:
City	:	NEENAH
State	:	WI
Zip	:	54956-2708
Country	:	US
Telephone Number	:	920-486-4031
Fax Number	:	920-725-2909

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	04/07/2014

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