=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639311756
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHIROPRACTIC HEALTH CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2009
-----------------------------------------------------
Last Update Date | 04/03/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3227 E WARM SPRINGS RD
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89120-3179
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-597-1181
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2267 CANDLESTICK AVE
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89052-2361
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-496-0636
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. DAVID B COHEN
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 702-597-1181
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NN1001X
-----------------------------------------------------
Taxonomy Name | Nutrition Chiropractor
-----------------------------------------------------
License Number | B-407
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------