Healthcare Provider Details

I. General information

NPI: 1679705172
Provider Name (Legal Business Name): OBRIEN CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2009
Last Update Date: 08/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6015 S FORT APACHE RD SUITE 180
LAS VEGAS NV
89148-5543
US

IV. Provider business mailing address

6015 S FORT APACHE RD SUITE 180
LAS VEGAS NV
89148-5543
US

V. Phone/Fax

Practice location:
  • Phone: 702-739-6984
  • Fax: 702-739-6904
Mailing address:
  • Phone: 702-739-6984
  • Fax: 702-739-6904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberB01292
License Number StateNV

VIII. Authorized Official

Name: DR. JASON THOMAS O'BRIEN
Title or Position: OWNER
Credential: D.C.
Phone: 702-739-6984