Healthcare Provider Details

I. General information

NPI: 1427100692
Provider Name (Legal Business Name): DANIEL JOSEPH RAGUSA D.C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3146 N RAINBOW BLVD
LAS VEGAS NV
89108-4533
US

IV. Provider business mailing address

209 LOGANSBERRY LN
LAS VEGAS NV
89145-4739
US

V. Phone/Fax

Practice location:
  • Phone: 702-658-7777
  • Fax: 702-658-2016
Mailing address:
  • Phone: 702-204-7469
  • Fax: 702-658-2016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberB-794
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: