MEDICARE: ADVANCED SPINE & REHABILITATION

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	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1417824707
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED SPINE & REHABILITATION

Provider Business Mailing Address
First Line	:	2168 W GROVE PKWY STE 200
Second Line	:
City	:	PLEASANT GROVE
State	:	UT
Zip	:	84062-6748
Country	:	US
Telephone Number	:	702-852-1390
Fax Number	:	702-567-7333

Provider Business Practice Location Address
First Line	:	241 N BUFFALO DR STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-0307
Country	:	US
Telephone Number	:	702-852-1390
Fax Number	:	702-567-7333

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NATE D MILLER
Credential	:	DC
Telephone Number	:	702-852-1390

Provider Enumeration Date	:	10/21/2025
Last Update Date	:	10/21/2025

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