Healthcare Provider Details

I. General information

NPI: 1770653255
Provider Name (Legal Business Name): ADVANCED CHIROPRACTIC ORTHOPEDICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 11/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6837 W CHARLESTON BLVD
LAS VEGAS NV
89117-1635
US

IV. Provider business mailing address

6837 W CHARLESTON BLVD
LAS VEGAS NV
89117-1635
US

V. Phone/Fax

Practice location:
  • Phone: 702-240-0520
  • Fax: 702-240-2072
Mailing address:
  • Phone: 702-240-0520
  • Fax: 702-240-2072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberB00386
License Number StateNV

VIII. Authorized Official

Name: DR. RODNEY PERRY
Title or Position: PRES SEC
Credential: D.C.
Phone: 702-240-0520