Individual
ILL NAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C
Contact information
Practice address
505 S. DECATUR BLVD, LAS VEGAS, NV 89107
(702) 870-7582
(702) 870-7583
Mailing address
505 S. DECATUR BLVD, LAS VEGAS, NV 89107
(702) 870-7582
(702) 870-7583
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
B01417
NV
Other
Enumeration date
04/22/2011
Last updated
11/16/2022
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