Healthcare Provider Details

I. General information

NPI: 1518574169
Provider Name (Legal Business Name): TREVELYNN HENUSET DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7975 BADURA AVE STE 1015
LAS VEGAS NV
89113-2156
US

IV. Provider business mailing address

207 PRIVILEGE CT
HENDERSON NV
89052-5656
US

V. Phone/Fax

Practice location:
  • Phone: 702-966-5920
  • Fax:
Mailing address:
  • Phone: 702-491-7135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberB00970
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: