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General NPI Number Information
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NPI Number | 1598820185
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE FAMILY MEDICINE
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 04/12/2010
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Provider Practice Location Address
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Address Line | 4955 S DURANGO DR #106
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City | LAS VEGAS
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State | NV
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Zip | 89113-1053
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Country | US
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Telephone | 702-562-8800
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Fax | 702-562-0009
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Provider Business Mailing Address
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Address Line | 4955 S DURANGO DR #106
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City | LAS VEGAS
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State | NV
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Zip | 89113-1053
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Country | US
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Telephone | 702-562-8800
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Fax | 702-562-0009
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Authorized Official
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Title or Position | CO-OWNER/CHIROPRACTOR
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Name | COREY A WACHS
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Credential | DC
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Telephone | 702-562-8800
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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 | B00709
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 585
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 9444
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License Number State | NV
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