Healthcare Provider Details

I. General information

NPI: 1386842532
Provider Name (Legal Business Name): PAUL DOUGLAS ROVETTI D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 GREENBRAE DR SUITE C
SPARKS NV
89431-3171
US

IV. Provider business mailing address

655 GREENBRAE DR SUITE C
SPARKS NV
89431-3171
US

V. Phone/Fax

Practice location:
  • Phone: 775-355-1231
  • Fax: 775-358-6843
Mailing address:
  • Phone: 775-355-1231
  • Fax: 775-358-6843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberB-328
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: