MEDICARE: DR. LAC DINH 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	DC007840L	PA

General Provider Information

NPI Number	:	1821309212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAC DINH NGUYEN DC

Provider Business Mailing Address
First Line	:	1100 WASHINGTON AVE
Second Line	:	LOT C , UNIT C-2
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-3802
Country	:	US
Telephone Number	:	215-468-7256
Fax Number	:	215-468-7192

Provider Business Practice Location Address
First Line	:	1100 WASHINGTON AVE
Second Line	:	LOT C , UNIT C-2
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-3802
Country	:	US
Telephone Number	:	215-468-7256
Fax Number	:	215-468-7192

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

Provider Enumeration Date	:	06/30/2010
Last Update Date	:	06/30/2010

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