MEDICARE: WRIGHT CHIROPRACTIC LLC

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	B00901	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CC5981	OTHER	NV	BCBS

General Provider Information

NPI Number	:	1588743967
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WRIGHT CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	6430 SKY POINTE DRIVE
Second Line	:	SUITE 150
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-4051
Country	:	US
Telephone Number	:	702-318-4774
Fax Number	:	702-318-4775

Provider Business Practice Location Address
First Line	:	6430 SKY POINTE DRIVE
Second Line	:	SUITE 150
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-4051
Country	:	US
Telephone Number	:	702-318-4774
Fax Number	:	702-318-4775

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	DR. LOREN WILLIS WRIGHT
Credential	:	DC
Telephone Number	:	702-318-4774

Provider Enumeration Date	:	11/04/2006
Last Update Date	:	04/11/2016

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Directions to “WRIGHT CHIROPRACTIC LLC ” Practice Location

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