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General NPI Number Information
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NPI Number | 1609291285
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Entity Type | Organization
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Legal Business Name | HIGH DESERT FAMILY CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 02/19/2014
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Last Update Date | 02/19/2014
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Provider Practice Location Address
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Address Line | 3200 TRADERS WAY STE C
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City | WINNEMUCCA
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State | NV
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Zip | 89445-3683
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Country | US
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Telephone | 775-623-3200
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Fax | 775-623-3299
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Provider Business Mailing Address
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Address Line | 3200 TRADERS WAY STE C
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City | WINNEMUCCA
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State | NV
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Zip | 89445-3683
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Country | US
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Telephone | 775-623-3200
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Fax | 775-623-3299
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. CLINTON JAMES LOW
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Credential | D.C.
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Telephone | 775-623-3200
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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 | B01314
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License Number State | NV
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