MEDICARE: DR. ROLAND KEITH BRIM D.C.

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	B01525	NV

General Provider Information

NPI Number	:	1962606814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROLAND KEITH BRIM D.C.

Provider Business Mailing Address
First Line	:	2320 PASEO DEL PRADO STE B304
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-4335
Country	:	US
Telephone Number	:	702-479-6650
Fax Number	:	702-938-9066

Provider Business Practice Location Address
First Line	:	2320 PASEO DEL PRADO
Second Line	:	STE B304
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-4335
Country	:	US
Telephone Number	:	760-948-4870
Fax Number	:	760-948-9612

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

Provider Enumeration Date	:	06/13/2007
Last Update Date	:	12/21/2022

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