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NPI Code Detail

MEDICARE: DR. JONATHAN WILLIAM WISE D.C.

MEDICARE:  DR. JONATHAN WILLIAM WISE  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
1111N00000XChiropractorB01251NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1B01251OTHERNVNEVADA CHIROPRACTIC LICEN

General Provider Information

NPI Number : 1558562637
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JONATHAN WILLIAM WISE D.C.
Provider Business Mailing Address
First Line : 5875 S RAINBOW BLVD STE 201
Second Line :
City : LAS VEGAS
State : NV
Zip : 89118-2556
Country : US
Telephone Number : 702-248-6292
Fax Number : 702-643-6292
Provider Business Practice Location Address
First Line : 5875 S RAINBOW BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89118-2554
Country : US
Telephone Number : 702-248-6292
Fax Number : 702-643-6292
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/29/2007
Last Update Date : 03/18/2009

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Directions to “ DR. JONATHAN WILLIAM WISE D.C.” Practice Location

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