MEDICARE: CHUONG VAN PHAM 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	9847	TX

General Provider Information

NPI Number	:	1992767313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHUONG VAN PHAM D.C.

Provider Business Mailing Address
First Line	:	5763 FALL CREEK CT
Second Line	:
City	:	HALTOM CITY
State	:	TX
Zip	:	76137-2676
Country	:	US
Telephone Number	:	817-759-2777
Fax Number	:	817-759-2779

Provider Business Practice Location Address
First Line	:	1916 N BEACH ST
Second Line	:
City	:	HALTOM CITY
State	:	TX
Zip	:	76111-6703
Country	:	US
Telephone Number	:	817-759-2777
Fax Number	:	817-759-2779

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

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	07/08/2007

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Directions to “ CHUONG VAN PHAM D.C.” Practice Location

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