MEDICARE: WELL ADJUSTED CHIROPRACTIC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CM00109587	OTHER	NV	MALPRACTICE INSURANCE
2	B01255	OTHER	NV	CHIROPRACTIC CERTIFICATE

General Provider Information

NPI Number	:	1497417026
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELL ADJUSTED CHIROPRACTIC

Provider Business Mailing Address
First Line	:	3315 W CRAIG RD STE 105
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-5001
Country	:	US
Telephone Number	:	702-735-7246
Fax Number	:	702-489-7556

Provider Business Practice Location Address
First Line	:	3315 W CRAIG RD STE 105
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-5001
Country	:	US
Telephone Number	:	702-735-7246
Fax Number	:	702-489-7556

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RALPH IANACONE
Credential	:	CHIROPRACTIC PHYSICI
Telephone Number	:	702-735-7246

Provider Enumeration Date	:	10/11/2021
Last Update Date	:	10/11/2021

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Directions to “WELL ADJUSTED CHIROPRACTIC ” Practice Location

Language	Start Address	Practice Location

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