Healthcare Provider Details

I. General information

NPI: 1760482756
Provider Name (Legal Business Name): RICHARD MATTHEW MCINTYRE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9555 S EASTERN AVE SUITE 240
LAS VEGAS NV
89123-8008
US

IV. Provider business mailing address

3046 HARTSVILLE RD
HENDERSON NV
89052-8514
US

V. Phone/Fax

Practice location:
  • Phone: 702-301-3862
  • Fax: 702-914-6950
Mailing address:
  • Phone: 702-914-6950
  • Fax: 702-914-6950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberB 149
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: