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General NPI Number Information
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NPI Number | 1902902539
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Entity Type | Individual
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Provider Name | BRUCE C KOELLIKER DC
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Gender | Male
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 01/18/2008
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Provider Practice Location Address
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Address Line | 9775 S MARYLAND PKWY STE A
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City | LAS VEGAS
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State | NV
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Zip | 89183
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Country | US
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Telephone | 702-837-0392
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Fax | 702-320-4148
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Provider Business Mailing Address
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Address Line | 9775 S MARYLAND PARKWAY SUITE A
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City | LAS VEGAS
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State | NV
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Zip | 89183
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Country | US
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Telephone | 702-837-0392
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Fax | 702-320-4148
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | B646
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License Number State | NV
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