MEDICARE: HOLLYWOOD WELLNESS ASSOCIATES, 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	B01408	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B01408	OTHER	NV	LICENSE #

General Provider Information

NPI Number	:	1396023222
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLLYWOOD WELLNESS ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	5568 S FORT APACHE RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-3602
Country	:	US
Telephone Number	:	623-399-8606
Fax Number	:	623-399-9958

Provider Business Practice Location Address
First Line	:	5568 S FORT APACHE RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-3602
Country	:	US
Telephone Number	:	623-399-8606
Fax Number	:	623-399-9958

Authorized Official
Title or Position	:	CEO
Name	:	MATTHEW J EMMONS
Credential	:	D.C.
Telephone Number	:	602-881-5430

Provider Enumeration Date	:	07/26/2011
Last Update Date	:	07/26/2011

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Directions to “HOLLYWOOD WELLNESS ASSOCIATES, INC. ” Practice Location

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