Healthcare Provider Details

I. General information

NPI: 1992073027
Provider Name (Legal Business Name): GREENAWALT CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2011
Last Update Date: 12/04/2011
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: 702-363-8989
  • Fax: 702-363-3573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberB362
License Number StateNV

VIII. Authorized Official

Name: DR. RONALD LEE GREENAWALT
Title or Position: CHIROPRACTIC PHYSICIAN/OWNER
Credential: D.C.
Phone: 702-363-8989