MEDICARE: DESERT INN CHIROPRACTIC CENTER

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	B00700	NV

General Provider Information

NPI Number	:	1134241565
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESERT INN CHIROPRACTIC CENTER

Provider Business Mailing Address
First Line	:	3771 E DESERT INN RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-3338
Country	:	US
Telephone Number	:	702-454-3775
Fax Number	:	702-454-7407

Provider Business Practice Location Address
First Line	:	3771 E DESERT INN RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-3338
Country	:	US
Telephone Number	:	702-454-3775
Fax Number	:	702-454-7407

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WAYNE DOUGLAS MANTEL
Credential	:	D.C.
Telephone Number	:	702-454-3775

Provider Enumeration Date	:	04/05/2007
Last Update Date	:	08/22/2020

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