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General NPI Number Information
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NPI Number | 1902076425
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Entity Type | Organization
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Legal Business Name | 5 STAR MOBILE CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 03/12/2008
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Last Update Date | 03/12/2008
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Provider Practice Location Address
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Address Line | 2440 MILLCROFT DR
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City | HENDERSON
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State | NV
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Zip | 89074-4956
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Country | US
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Telephone | 702-506-6922
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Fax | 702-456-5061
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Provider Business Mailing Address
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Address Line | 2440 MILLCROFT DR
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City | HENDERSON
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State | NV
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Zip | 89074-4956
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Country | US
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Telephone | 702-506-6922
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Fax | 702-456-5061
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Authorized Official
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Title or Position | CHIROPRACTIC PHYSICIAN/MANAGER
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Name | DR. MICHAEL TODD HANDELMAN
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Credential | D.C.
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Telephone | 702-506-6922
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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 | B-00861
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License Number State | NV
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