MEDICARE: BACK TO HEALTH CHIROPRACTIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	B01178	NV

General Provider Information

NPI Number	:	1477563963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACK TO HEALTH CHIROPRACTIC

Provider Business Mailing Address
First Line	:	1275 ARDIA ST
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89012-4823
Country	:	US
Telephone Number	:	702-566-6462
Fax Number	:

Provider Business Practice Location Address
First Line	:	4660 S EASTERN AVE
Second Line	:	SUITE 202
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6137
Country	:	US
Telephone Number	:	702-598-0500
Fax Number	:	702-433-0029

Authorized Official
Title or Position	:	OWNER
Name	:	LUIS F VALERA
Credential	:	D.C.
Telephone Number	:	702-598-0500

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	08/22/2020

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Practice Location Address:

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1265515696 — TON VINH LEE X D.D.S.
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1083800429 — DR. THEODORE ALBERT MCWILLIE D.D.S.
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1285958900 — BILINGUAL BEHAVIORAL SERVICES
Practice Location Address:

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