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General NPI Number Information
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NPI Number | 1093905887
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Entity Type | Organization
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Legal Business Name | BOULDER CHIROPRACTIC INC.
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Dates
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Enumeration Date | 07/27/2007
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Last Update Date | 11/01/2007
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Provider Practice Location Address
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Address Line | 806 BUCHANAN BLVD # 109
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City | BOULDER CITY
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State | NV
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Zip | 89005-2130
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Country | US
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Telephone | 702-293-0041
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Fax | 702-293-2834
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Provider Business Mailing Address
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Address Line | 806 BUCHANAN BLVD # 109
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City | BOULDER CITY
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State | NV
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Zip | 89005-2130
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Country | US
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Telephone | 702-293-0041
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Fax | 702-293-2834
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Authorized Official
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Title or Position | PRESIDENT
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Name | TAD N TENNEY
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Credential | DC
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Telephone | 702-293-0041
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | B-780
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License Number State | NV
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