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General NPI Number Information
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NPI Number | 1861735755
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Entity Type | Organization
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Legal Business Name | LIFECLINIC CHIROPRACTIC OF NEVADA LLC
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Dates
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Enumeration Date | 03/29/2013
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Last Update Date | 10/13/2015
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Provider Practice Location Address
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Address Line | 121 CARNEGIE STREET
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City | HENDERSON
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State | NV
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Zip | 89052-7118
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Country | US
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Telephone | 952-229-7558
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 549
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City | CHANHASSEN
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State | MN
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Zip | 55317-0549
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | REZA POUR ALIZADEH
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Credential | DC
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Telephone | 651-690-0866
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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 |
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License Number State |
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