MEDICARE: DR. KEVIN KEI NOZAWA D.C.

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	B673	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	V111805	OTHER	NV	MEDICARE PTAN

General Provider Information

NPI Number	:	1134281413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN KEI NOZAWA D.C.

Provider Business Mailing Address
First Line	:	7250 PEAK DR
Second Line	:	STE 100
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-9028
Country	:	US
Telephone Number	:	702-386-4700
Fax Number	:	702-386-4701

Provider Business Practice Location Address
First Line	:	7220 S CIMARRON RD
Second Line	:	SUITE 270
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-2159
Country	:	US
Telephone Number	:	702-623-5564
Fax Number	:	702-386-4701

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

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	07/27/2016

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