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General NPI Number Information
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NPI Number | 1417148354
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Entity Type | Organization
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Legal Business Name | DESERT VALLEY CHIROPRACTIC
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Dates
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Enumeration Date | 08/06/2007
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Last Update Date | 09/27/2007
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Provider Practice Location Address
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Address Line | 2340 E CALVADA BLVD STE 3
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City | PAHRUMP
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State | NV
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Zip | 89048-5821
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Country | US
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Telephone | 775-727-0888
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Fax | 775-727-2362
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Provider Business Mailing Address
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Address Line | 2340 E CALVADA BLVD STE 3
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City | PAHRUMP
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State | NV
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Zip | 89048-5821
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Country | US
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Telephone | 775-727-0888
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Fax | 775-727-2362
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. SAM D COLARUSSO
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Credential | D.C,
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Telephone | 775-727-0888
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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-0871
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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 | B-0613
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License Number State | NV
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