MEDICARE: DR. DOUGLAS B HERMANSEN DC

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	B498	NV
2	111N00000X	Chiropractor	B498 295368-1202	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	V100640	OTHER		MEDICARE GROUP #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1891850459	OTHER	NV	NPI #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1497873475	OTHER		NPI GROUP #

General Provider Information

NPI Number	:	1891850459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS B HERMANSEN DC

Provider Business Mailing Address
First Line	:	3551 E BONANZA RD
Second Line	:	#108
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-2198
Country	:	US
Telephone Number	:	702-437-0800
Fax Number	:	702-437-7857

Provider Business Practice Location Address
First Line	:	3551 E BONANZA RD
Second Line	:	#108
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-2198
Country	:	US
Telephone Number	:	702-437-0800
Fax Number	:	702-437-7857

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

Provider Enumeration Date	:	12/26/2006
Last Update Date	:	03/20/2009

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Directions to “ DR. DOUGLAS B HERMANSEN DC” Practice Location

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