MEDICARE: DR. CHAD WHEATLEY D.C.

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	B01533	NV

General Provider Information

NPI Number	:	1497165120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHAD WHEATLEY D.C.

Provider Business Mailing Address
First Line	:	4955 S DURANGO DR
Second Line	:	SUITE 213
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-0152
Country	:	US
Telephone Number	:	702-247-4250
Fax Number	:

Provider Business Practice Location Address
First Line	:	6090 S FORT APACHE RD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148
Country	:	US
Telephone Number	:	702-247-4250
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2014
Last Update Date	:	08/11/2018

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