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General NPI Number Information
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NPI Number | 1417624073
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Entity Type | Individual
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Provider Name | SHATTUCK KUZMIC D.C.
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Gender | Male
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Dates
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Enumeration Date | 08/23/2021
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Last Update Date | 12/01/2022
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Provider Practice Location Address
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Address Line | 1930 VILLAGE CENTER CIR # H11
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City | LAS VEGAS
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State | NV
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Zip | 89134-6299
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Country | US
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Telephone | 702-566-4673
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Fax |
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Provider Business Mailing Address
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Address Line | 580 VITANO ST
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City | LAS VEGAS
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State | NV
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Zip | 89138-7513
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Country | US
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Telephone | 503-686-0517
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | CHIA-2050
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License Number State | ID
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