Healthcare Provider Details

I. General information

NPI: 1831736693
Provider Name (Legal Business Name): BACK 2 RELIEF VEGAS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2019
Last Update Date: 11/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3455 E LAKE MEAD BLVD STE 1
NORTH LAS VEGAS NV
89030-7328
US

IV. Provider business mailing address

PO BOX 971532
OREM UT
84097-1532
US

V. Phone/Fax

Practice location:
  • Phone: 702-642-1300
  • Fax:
Mailing address:
  • Phone: 801-319-1120
  • Fax: 888-509-2322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. RODOLFO MARTINEZ-FERRATE
Title or Position: DIRECTOR
Credential: MD
Phone: 801-651-4283