Healthcare Provider Details

I. General information

NPI: 1063931269
Provider Name (Legal Business Name): GOLAN INTEGRATED PHYSICAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2017
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 E CALVADA BLVD
PAHRUMP NV
89048-5805
US

IV. Provider business mailing address

2100 E CALVADA BLVD
PAHRUMP NV
89048-5805
US

V. Phone/Fax

Practice location:
  • Phone: 775-727-7959
  • Fax: 775-727-7960
Mailing address:
  • Phone: 775-727-7959
  • Fax: 775-727-7960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateNV

VIII. Authorized Official

Name: ANNA CHRISTENSEN
Title or Position: MANAGER
Credential:
Phone: 775-727-7959