Provider Demographics
NPI:1437960564
Name:NGUYEN, JENNIE
Entity type:Individual
Prefix:
First Name:JENNIE
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 W POPLAR AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-2577
Mailing Address - Country:US
Mailing Address - Phone:901-316-8762
Mailing Address - Fax:901-424-0976
Practice Address - Street 1:1011 W POPLAR AVE STE 1
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-2577
Practice Address - Country:US
Practice Address - Phone:901-316-8762
Practice Address - Fax:901-424-0976
Is Sole Proprietor?:No
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1349111N00000X
TN2741111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor