MEDICARE: ROBERTO JOSE MEDINA 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
1	111N00000X	Chiropractor	B01794	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B01794	OTHER	NV	CHIROPRACTIC PHYSICIANS BOARD OF NEVADA

General Provider Information

NPI Number	:	1013559533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERTO JOSE MEDINA DC

Provider Business Mailing Address
First Line	:	8678 SPRING MOUNTAIN RD STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-4103
Country	:	US
Telephone Number	:	702-644-3333
Fax Number	:	702-644-3336

Provider Business Practice Location Address
First Line	:	8678 SPRING MOUNTAIN RD STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-4103
Country	:	US
Telephone Number	:	702-644-3333
Fax Number	:	702-644-3336

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2019
Last Update Date	:	11/27/2023

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Directions to “ ROBERTO JOSE MEDINA DC” Practice Location

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