Healthcare Provider Details

I. General information

NPI: 1124397260
Provider Name (Legal Business Name): ROBERT CHASE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2011
Last Update Date: 02/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2329 RICHARD DR.
HENDERSON NV
89014
US

IV. Provider business mailing address

2329 RICHARD DR
HENDERSON NV
89014-3773
US

V. Phone/Fax

Practice location:
  • Phone: 702-583-0455
  • Fax: 702-685-7766
Mailing address:
  • Phone: 702-583-0455
  • Fax: 702-685-7766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberB00609
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License NumberB-609
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: