Healthcare Provider Details

I. General information

NPI: 1114286622
Provider Name (Legal Business Name): HOLLYWOOD WELLNESS ASSOCIATES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2012
Last Update Date: 05/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5568 S FORT APACHE RD
LAS VEGAS NV
89148-3602
US

IV. Provider business mailing address

5568 S FORT APACHE RD
LAS VEGAS NV
89148-3602
US

V. Phone/Fax

Practice location:
  • Phone: 702-305-1104
  • Fax:
Mailing address:
  • Phone: 702-305-1104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License NumberB01408
License Number StateNV

VIII. Authorized Official

Name: DR. MATTHEW JAMES EMMONS
Title or Position: CEO
Credential: D.C
Phone: 702-305-1104