MEDICARE: CENTENNIAL 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	B00803	NV

General Provider Information

NPI Number	:	1346674785
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTENNIAL WELLNESS CENTER

Provider Business Mailing Address
First Line	:	7910 W TROPICAL PKWY
Second Line	:	STE. 110
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-4554
Country	:	US
Telephone Number	:	702-458-2225
Fax Number	:	702-396-4536

Provider Business Practice Location Address
First Line	:	7910 W TROPICAL PKWY
Second Line	:	STE. 110
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-4554
Country	:	US
Telephone Number	:	702-458-2225
Fax Number	:	702-396-4536

Authorized Official
Title or Position	:	OWNER/ CHIROPRACTOR
Name	:	DR. DANIELLE BUDA
Credential	:	D.C.
Telephone Number	:	702-458-2225

Provider Enumeration Date	:	08/21/2013
Last Update Date	:	08/21/2013

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