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NPI Code Detail

MEDICARE: DR. RICHARD HOANI KANANI POULSEN DC

MEDICARE: DR. RICHARD HOANI KANANI POULSEN DC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractorB01795NV

General Provider Information

NPI Number : 1003458639
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RICHARD HOANI KANANI POULSEN DC
Provider Business Mailing Address
First Line : 8678 SPRING MOUNTAIN RD STE 130
Second Line :
City : LAS VEGAS
State : NV
Zip : 89117-4104
Country : US
Telephone Number : 702-384-0000
Fax Number :
Provider Business Practice Location Address
First Line : 8678 SPRING MOUNTAIN RD STE 130
Second Line :
City : LAS VEGAS
State : NV
Zip : 89117-4104
Country : US
Telephone Number : 702-384-0000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/15/2019
Last Update Date : 10/15/2019

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