MEDICARE: PROGRESSIVE HEALTH CENTER OF NEVADA, LLC

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	:	1447425822
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRESSIVE HEALTH CENTER OF NEVADA, LLC

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	:	517-204-2268
Fax Number	:

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	:	517-204-2268
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. MICHAEL J. SOBRAN
Credential	:	D.C.
Telephone Number	:	517-204-2268

Provider Enumeration Date	:	04/25/2008
Last Update Date	:	07/31/2008

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