MEDICARE: DR. TRUONG PHAM D.C.,CERTIFIED ACUP

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	2004001514	MO

General Provider Information

NPI Number	:	1932124716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRUONG PHAM D.C.,CERTIFIED ACUP

Provider Business Mailing Address
First Line	:	2014 SWIFT AVE.
Second Line	:
City	:	NORTH KANSAS CITY
State	:	MO
Zip	:	64116-3424
Country	:	US
Telephone Number	:	816-221-7426
Fax Number	:

Provider Business Practice Location Address
First Line	:	2014 SWIFT AVE
Second Line	:
City	:	NORTH KANSAS CITY
State	:	MO
Zip	:	64116-3424
Country	:	US
Telephone Number	:	816-221-7426
Fax Number	:	816-221-7426

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	11/14/2007

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