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General NPI Number Information
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NPI Number | 1922140557
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Entity Type | Organization
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Legal Business Name | NEVADA SPINE AND DISC
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 03/30/2009
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Provider Practice Location Address
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Address Line | 8665 S EASTERN AVE SPACE 3
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City | LAS VEGAS
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State | NV
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Zip | 89123-2839
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Country | US
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Telephone | 702-581-6388
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Fax | 702-616-7330
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Provider Business Mailing Address
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Address Line | 1417 FOOTHILLS MILLS ST
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City | HENDERSON
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State | NV
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Zip | 89012-4837
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Country | US
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Telephone | 702-581-6388
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Fax | 702-616-7330
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STUART MCINTYRE COCKS
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Credential | D.C.
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Telephone | 702-581-6388
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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 | B00204
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License Number State | NV
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