MEDICARE: VIDA CHIROPRACTIC INJURY CLINIC AND WELLNESS 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

General Provider Information

NPI Number	:	1194675413
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIDA CHIROPRACTIC INJURY CLINIC AND WELLNESS CENTER

Provider Business Mailing Address
First Line	:	2352 E BONANZA RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-3451
Country	:	US
Telephone Number	:	702-678-8888
Fax Number	:

Provider Business Practice Location Address
First Line	:	2352 E BONANZA RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-3451
Country	:	US
Telephone Number	:	702-678-8888
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. CESAR O QUINTANA
Credential	:	D.C.
Telephone Number	:	702-686-9270

Provider Enumeration Date	:	01/28/2026
Last Update Date	:	01/28/2026

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