Healthcare Provider Details

I. General information

NPI: 1649465279
Provider Name (Legal Business Name): ADVANCED NECK AND BACK CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 09/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3146 N RAINBOW BLVD
LAS VEGAS NV
89108-4533
US

IV. Provider business mailing address

3146 N RAINBOW BLVD
LAS VEGAS NV
89108-4533
US

V. Phone/Fax

Practice location:
  • Phone: 702-658-7777
  • Fax: 702-658-2016
Mailing address:
  • Phone: 702-658-7777
  • Fax: 702-658-2016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberB794
License Number StateNV

VIII. Authorized Official

Name: DR. DANIEL JOSEPH RAGUSA
Title or Position: CHIROPRACTOR
Credential: D.C
Phone: 702-658-7777