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General NPI Number Information
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NPI Number | 1902068299
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Entity Type | Organization
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Legal Business Name | ACE CHIROPRACTIC NEVADA LTD
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Dates
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Enumeration Date | 06/27/2008
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Last Update Date | 06/27/2008
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Provider Practice Location Address
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Address Line | 10075 SOUTH EASTERN AVENUE SUITE 110
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City | HENDERSON
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State | NV
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Zip | 89052
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Country | US
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Telephone | 702-614-8778
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Fax | 702-614-0051
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Provider Business Mailing Address
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Address Line | 10075 SOUTH EASTERN AVENUE SUITE 110
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City | HENDERSON
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State | NV
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Zip | 89052
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Country | US
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Telephone | 702-614-8778
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Fax | 702-614-0051
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. KEITH L QUISBERG
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Credential | DO
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Telephone | 702-614-8778
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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 | B0993
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License Number State | NV
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