Healthcare Provider Details

I. General information

NPI: 1518278076
Provider Name (Legal Business Name): TIMOTHY DUTT D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 11/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 W SAHARA AVE
LAS VEGAS NV
89117-2742
US

IV. Provider business mailing address

7500 W SAHARA AVE
LAS VEGAS NV
89117-2742
US

V. Phone/Fax

Practice location:
  • Phone: 702-363-8989
  • Fax: 702-363-3573
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberB01310
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: