Healthcare Provider Details

I. General information

NPI: 1962604249
Provider Name (Legal Business Name): WADE J SIEGEL D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 01/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3430 N BUFFALO DR. STE 110
LAS VEGAS NV
89129
US

IV. Provider business mailing address

PO BOX 36853
LAS VEGAS NV
89133-6853
US

V. Phone/Fax

Practice location:
  • Phone: 702-255-5930
  • Fax: 702-515-0803
Mailing address:
  • Phone: 702-644-3333
  • Fax: 702-644-3336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberB782
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberB00782
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: