Healthcare Provider Details

I. General information

NPI: 1255541330
Provider Name (Legal Business Name): SCOTT PAUL GILLESPIE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 05/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8576 W LAKE MEAD BLVD
LAS VEGAS NV
89128-7630
US

IV. Provider business mailing address

8576 W LAKE MEAD BLVD
LAS VEGAS NV
89128-7630
US

V. Phone/Fax

Practice location:
  • Phone: 702-255-3003
  • Fax:
Mailing address:
  • Phone: 702-255-3003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberB01296
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: