MEDICARE: ADVANCED CHIROPRACTIC AT SPECIALTY MEDICAL

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	111NR0400X	Rehabilitation Chiropractor	111N00000X	NV

General Provider Information

NPI Number	:	1285779074
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED CHIROPRACTIC AT SPECIALTY MEDICAL

Provider Business Mailing Address
First Line	:	1151 S HIGHWAY 160
Second Line	:
City	:	PAHRUMP
State	:	NV
Zip	:	89048-4700
Country	:	US
Telephone Number	:	775-727-1188
Fax Number	:	775-727-1136

Provider Business Practice Location Address
First Line	:	1151 S HIGHWAY 160
Second Line	:
City	:	PAHRUMP
State	:	NV
Zip	:	89048-4700
Country	:	US
Telephone Number	:	775-727-1188
Fax Number	:	775-727-1136

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GEORGES TANNOURY X
Credential	:	M.D.
Telephone Number	:	775-727-1188

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	08/22/2020

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