Provider Demographics
NPI:1578645826
Name:PHAM, TRUC N (DC)
Entity type:Individual
Prefix:
First Name:TRUC
Middle Name:N
Last Name:PHAM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:639 TULLY RD STE G
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95111-1000
Mailing Address - Country:US
Mailing Address - Phone:408-947-8684
Mailing Address - Fax:408-947-0321
Practice Address - Street 1:639 TULLY RD STE G
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95111-1000
Practice Address - Country:US
Practice Address - Phone:408-947-8684
Practice Address - Fax:408-947-0321
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26797111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU82638Medicare UPIN
CADC0267970Medicare ID - Type Unspecified