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NPI Code Detail

MEDICARE: DR. DAVID C KETCHUM D.C.

MEDICARE: DR. DAVID C KETCHUM D.C.
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
1111NS0005XSports Physician ChiropractorB842NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1B842OTHERNVCHIR BD OF NV LICENSE

General Provider Information

NPI Number : 1467458067
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID C KETCHUM D.C.
Provider Business Mailing Address
First Line : 2647 BOX CANYON DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128-0450
Country : US
Telephone Number : 702-363-5575
Fax Number : 702-646-1727
Provider Business Practice Location Address
First Line : 2647 BOX CANYON DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128-0450
Country : US
Telephone Number : 702-363-5575
Fax Number : 702-646-1727
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2005
Last Update Date : 07/09/2007

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Directions to “ DR. DAVID C KETCHUM D.C.” Practice Location

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