MEDICARE: CANOWA SUB 1

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	B79	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	V106920	OTHER	NV	MEDICARE PTAN

General Provider Information

NPI Number	:	1962406686
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CANOWA SUB 1

Provider Business Mailing Address
First Line	:	2091 E SAHARA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-3829
Country	:	US
Telephone Number	:	702-732-4044
Fax Number	:	702-732-8396

Provider Business Practice Location Address
First Line	:	2091 E SAHARA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-3829
Country	:	US
Telephone Number	:	702-732-4044
Fax Number	:	702-732-8396

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LARRY P. SCHLEUSNER
Credential	:	D.C.
Telephone Number	:	702-732-4044

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	03/07/2014

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Directions to “CANOWA SUB 1 ” Practice Location

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