=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417824707
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED SPINE & REHABILITATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2025
-----------------------------------------------------
Last Update Date | 10/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 241 N BUFFALO DR STE 100
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89145-0307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-852-1390
-----------------------------------------------------
Fax | 702-567-7333
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2168 W GROVE PKWY STE 200
-----------------------------------------------------
City | PLEASANT GROVE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84062-6748
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-852-1390
-----------------------------------------------------
Fax | 702-567-7333
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | NATE D MILLER
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 702-852-1390
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------