Healthcare Provider Details

I. General information

NPI: 1023297058
Provider Name (Legal Business Name): COLARUSSO AND NOZAWA LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 03/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6015 S FORT APACHE RD STE 180
LAS VEGAS NV
89148-5543
US

IV. Provider business mailing address

3417 WHITE BARK PINE ST
LAS VEGAS NV
89129-8119
US

V. Phone/Fax

Practice location:
  • Phone: 702-944-2225
  • Fax: 702-926-5560
Mailing address:
  • Phone: 702-254-2225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberB673
License Number StateNV

VIII. Authorized Official

Name: KEVIN K NOZAWA
Title or Position: SECRETARY
Credential: D.C.
Phone: 702-944-2225