Organization
PAC CHIROPRACTIC LLC
Active
Other names
PACIFIC CHIROPRACTIC
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY C HEINRICH (OFFICE MANAGER)
(702) 856-0665
Entity
Organization
Contact information
Practice address
204 W PACIFIC AVE, HENDERSON, NV 89015-7376
(702) 856-0665
(702) 675-8239
Mailing address
PO BOX 230819, LAS VEGAS, NV 89105-0819
(702) 856-0665
(702) 675-8239
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
B895
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003602035
—
NV
01
—
11384445
CAQH
NV
01
—
350054434
RAILROAD MEDICARE
NV
01
—
7835292
AETNA
NV
01
—
CC3751
BLUE CROSS/BLUE SHIELD
NV
Enumeration date
04/03/2013
Last updated
04/06/2014
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