Healthcare Provider Details

I. General information

NPI: 1144343450
Provider Name (Legal Business Name): LEADING EDGE CHIROPRACTIC LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10635 PROFESSIONAL CIR STE B
RENO NV
89521-5836
US

IV. Provider business mailing address

10635 PROFESSIONAL CIR STE B SUITE B
RENO NV
89521-5836
US

V. Phone/Fax

Practice location:
  • Phone: 775-284-4900
  • Fax: 775-284-4902
Mailing address:
  • Phone: 775-284-4900
  • Fax: 775-284-4902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberB01030
License Number StateNV

VIII. Authorized Official

Name: DR. BRYAN C HANSEN
Title or Position: OWNER/PRESIDENT
Credential: DC
Phone: 775-284-4900