Healthcare Provider Details

I. General information

NPI: 1588711758
Provider Name (Legal Business Name): MATTHEW CHARLES OLMSTEAD D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 05/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3430 N BUFFALO DR STE 110
LAS VEGAS NV
89129-7424
US

IV. Provider business mailing address

9309 IRONSEND ST
LAS VEGAS NV
89143-1138
US

V. Phone/Fax

Practice location:
  • Phone: 702-255-5930
  • Fax: 702-515-0803
Mailing address:
  • Phone: 702-655-7958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberB-991
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: