MEDICARE: NEVADA SPINE INSTITUTE

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	B00467	NV

General Provider Information

NPI Number	:	1467581090
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEVADA SPINE INSTITUTE

Provider Business Mailing Address
First Line	:	1485 W WARM SPRINGS RD STE 103
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89014-7632
Country	:	US
Telephone Number	:	702-450-0990
Fax Number	:	702-450-0993

Provider Business Practice Location Address
First Line	:	1485 W WARM SPRINGS RD STE 103
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89014-7632
Country	:	US
Telephone Number	:	702-450-0990
Fax Number	:	702-450-0993

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBERT GOODMAN
Credential	:	DC
Telephone Number	:	702-450-0990

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	08/22/2020

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Directions to “NEVADA SPINE INSTITUTE ” Practice Location

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