MEDICARE: NEVADA SPINE AND DISC

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	B00204	NV

General Provider Information

NPI Number	:	1922140557
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEVADA SPINE AND DISC

Provider Business Mailing Address
First Line	:	1417 FOOTHILLS MILLS ST
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89012-4837
Country	:	US
Telephone Number	:	702-581-6388
Fax Number	:	702-616-7330

Provider Business Practice Location Address
First Line	:	8665 S EASTERN AVE
Second Line	:	SPACE 3
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2839
Country	:	US
Telephone Number	:	702-581-6388
Fax Number	:	702-616-7330

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STUART MCINTYRE COCKS
Credential	:	D.C.
Telephone Number	:	702-581-6388

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	03/30/2009

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