Provider Demographics
NPI:1487623625
Name:NGUYEN, TESSA TOANAI (DC)
Entity type:Individual
Prefix:DR
First Name:TESSA
Middle Name:TOANAI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 EXECUTIVE CT
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-4542
Mailing Address - Country:US
Mailing Address - Phone:501-224-5557
Mailing Address - Fax:501-224-5571
Practice Address - Street 1:204 EXECUTIVE CT
Practice Address - Street 2:SUITE 110
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-4542
Practice Address - Country:US
Practice Address - Phone:501-224-5557
Practice Address - Fax:501-224-5571
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1635111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y670Medicare ID - Type Unspecified