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General NPI Number Information
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NPI Number | 1730236563
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Entity Type | Organization
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Legal Business Name | ACTIVE HEALTH CHIROPRACTIC LLC
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 07/08/2020
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Provider Practice Location Address
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Address Line | 7445 S DURANGO DR STE 105
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City | LAS VEGAS
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State | NV
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Zip | 89113-3611
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Country | US
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Telephone | 702-453-5000
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Fax | 702-453-3007
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Provider Business Mailing Address
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Address Line | 7445 S DURANGO DR STE 105
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City | LAS VEGAS
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State | NV
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Zip | 89113-3611
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Country | US
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Telephone | 702-453-5000
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Fax | 702-453-3007
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Authorized Official
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Title or Position | DOCTOR, MANAGING MEMBER
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Name | DR. DON VUONG
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Credential | D.C.
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Telephone | 702-453-5000
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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 | 217090
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License Number State | NV
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