Healthcare Provider Details

I. General information

NPI: 1093704421
Provider Name (Legal Business Name): RICK W. HALLGREN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4925 W CRAIG RD
LAS VEGAS NV
89130-2730
US

IV. Provider business mailing address

4925 W CRAIG RD
LAS VEGAS NV
89130-2730
US

V. Phone/Fax

Practice location:
  • Phone: 702-656-7460
  • Fax: 702-656-7461
Mailing address:
  • Phone: 702-656-7460
  • Fax: 702-656-7461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberB00519
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: