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General NPI Number Information
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NPI Number | 1437492899
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Entity Type | Organization
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Legal Business Name | PAC CHIROPRACTIC LLC
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Dates
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Enumeration Date | 04/03/2013
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Last Update Date | 04/06/2014
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Provider Practice Location Address
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Address Line | 204 W PACIFIC AVE
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City | HENDERSON
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State | NV
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Zip | 89015-7376
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Country | US
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Telephone | 702-856-0665
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Fax | 702-675-8239
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Provider Business Mailing Address
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Address Line | PO BOX 230819
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City | LAS VEGAS
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State | NV
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Zip | 89105-0819
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Country | US
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Telephone | 702-856-0665
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Fax | 702-675-8239
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. MARY C HEINRICH
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Credential |
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Telephone | 702-856-0665
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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 | B895
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License Number State | NV
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