MEDICARE: COMPLETE NECK & BACK CARE OF SUMMERLIN 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	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1255451340
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPLETE NECK & BACK CARE OF SUMMERLIN INC

Provider Business Mailing Address
First Line	:	1930 VILLAGE CENTER CIR STE 11
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-6238
Country	:	US
Telephone Number	:	702-363-3111
Fax Number	:	702-562-2822

Provider Business Practice Location Address
First Line	:	1930 VILLAGE CENTER CIR STE 11
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-6238
Country	:	US
Telephone Number	:	702-363-3111
Fax Number	:	702-562-2822

Authorized Official
Title or Position	:	OWNER/CHIROPRACTIC
Name	:	DR. MATTHEW SIMPSON
Credential	:	DC
Telephone Number	:	702-363-3111

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	06/16/2008

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