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General NPI Number Information
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NPI Number | 1346509064
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Entity Type | Organization
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Legal Business Name | WASHOE ACCIDENT AND INJURY CENTER, INC
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Dates
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Enumeration Date | 05/15/2012
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Last Update Date | 05/15/2012
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Provider Practice Location Address
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Address Line | 1625 E PRATER WAY SUITE 103
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City | SPARKS
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State | NV
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Zip | 89434-8969
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Country | US
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Telephone | 775-358-6824
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Fax | 775-358-6843
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Provider Business Mailing Address
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Address Line | 1625 E PRATER WAY SUITE 103
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City | SPARKS
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State | NV
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Zip | 89434-8969
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Country | US
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Telephone | 775-358-6824
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Fax | 775-358-6843
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Authorized Official
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Title or Position | PRESIDENT
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Name | DALE RAY KELLY
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Credential | DC
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Telephone | 775-358-6824
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | B00385
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License Number State | NV
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