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General NPI Number Information
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NPI Number | 1972876100
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Entity Type | Organization
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Legal Business Name | PICKLE, FLP
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Dates
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Enumeration Date | 02/19/2012
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Last Update Date | 02/19/2012
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Provider Practice Location Address
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Address Line | 501 S RANCHO DR
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City | LAS VEGAS
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State | NV
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Zip | 89106-4828
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Country | US
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Telephone | 702-491-6762
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Fax | 702-548-4343
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Provider Business Mailing Address
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Address Line | 2251 N RAMPART BLVD 163
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City | LAS VEGAS
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State | NV
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Zip | 89128-7640
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Country | US
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Telephone | 702-491-6762
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Fax | 702-548-4343
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. LAURA G JAGET
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Credential | DC
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Telephone | 702-491-6762
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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 | B00568
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License Number State | NV
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