MEDICARE: ADVANCED NECK AND BACK CARE, 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	B794	NV

General Provider Information

NPI Number	:	1649465279
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED NECK AND BACK CARE, LLC

Provider Business Mailing Address
First Line	:	3146 N RAINBOW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-4533
Country	:	US
Telephone Number	:	702-658-7777
Fax Number	:	702-658-2016

Provider Business Practice Location Address
First Line	:	3146 N RAINBOW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-4533
Country	:	US
Telephone Number	:	702-658-7777
Fax Number	:	702-658-2016

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. DANIEL JOSEPH RAGUSA
Credential	:	D.C
Telephone Number	:	702-658-7777

Provider Enumeration Date	:	09/06/2007
Last Update Date	:	09/06/2007

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