Healthcare Provider Details

I. General information

NPI: 1396365193
Provider Name (Legal Business Name): JILL VANLANDGHEN D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2020
Last Update Date: 04/21/2020
Certification Date: 04/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3061 S MARYLAND PKWY
LAS VEGAS NV
89109-2298
US

IV. Provider business mailing address

9599 W CHARLESTON BLVD APT 1083
LAS VEGAS NV
89117-6665
US

V. Phone/Fax

Practice location:
  • Phone: 702-478-9594
  • Fax: 702-478-9509
Mailing address:
  • Phone: 920-851-1688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberB01830
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: