Healthcare Provider Details

I. General information

NPI: 1518175363
Provider Name (Legal Business Name): NOWAKOWSKI & JOHNSON, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 08/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3085 E RUSSELL RD STE E
LAS VEGAS NV
89120-3473
US

IV. Provider business mailing address

3085 E RUSSELL RD STE E
LAS VEGAS NV
89120-3473
US

V. Phone/Fax

Practice location:
  • Phone: 702-433-8333
  • Fax: 702-433-4632
Mailing address:
  • Phone: 702-433-8333
  • Fax: 702-433-4632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberNV B 935
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License NumberNV B 928
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License NumberNV B 935
License Number StateNV
# 4
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberNV B 928
License Number StateNV

VIII. Authorized Official

Name: MS. SARAH ELIZABETH JOHNSON
Title or Position: DOCTOR OF CHIROPRACTIC
Credential: DC
Phone: 702-433-8333