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General NPI Number Information
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NPI Number | 1174696389
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Entity Type | Organization
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Legal Business Name | KIM BORSELLI DC LTD
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3300 S DECATUR BLVD #5
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City | LAS VEGAS
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State | NV
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Zip | 89102
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Country | US
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Telephone | 702-871-5556
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Fax | 702-871-5594
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Provider Business Mailing Address
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Address Line | 3300 S DECATUR BLVD #5
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City | LAS VEGAS
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State | NV
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Zip | 89102
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Country | US
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Telephone | 702-871-5556
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Fax | 702-871-5594
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Authorized Official
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Title or Position | OWNER
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Name | TERRY L WONG
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Credential | DC
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Telephone | 702-871-5556
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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 | B00691
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 21933
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 19363
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | B00492
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License Number State | NV
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