Healthcare Provider Details

I. General information

NPI: 1700084878
Provider Name (Legal Business Name): DANIEL PATRICK BUMGARNER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 S STEPHANIE ST STE 110
HENDERSON NV
89012-5555
US

IV. Provider business mailing address

1851 HILLPOINTE RD APT 212
HENDERSON NV
89074-0976
US

V. Phone/Fax

Practice location:
  • Phone: 702-767-0120
  • Fax: 702-545-0063
Mailing address:
  • Phone: 702-767-0120
  • Fax: 702-545-0063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberBO2000
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: