MEDICARE: HOLLYWOOD WELLNESS ASSOCIATES INC.

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	111NI0013X	Independent Medical Examiner Chiropractor	B01408	NV

General Provider Information

NPI Number	:	1114286622
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLLYWOOD WELLNESS ASSOCIATES INC.

Provider Business Mailing Address
First Line	:	5568 S FORT APACHE RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-3602
Country	:	US
Telephone Number	:	702-305-1104
Fax Number	:

Provider Business Practice Location Address
First Line	:	5568 S FORT APACHE RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-3602
Country	:	US
Telephone Number	:	702-305-1104
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. MATTHEW JAMES EMMONS
Credential	:	D.C
Telephone Number	:	702-305-1104

Provider Enumeration Date	:	05/04/2012
Last Update Date	:	05/04/2012

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