MEDICARE: DR. KRISSADA SCOTT VARNER DC

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	B01765	NV

General Provider Information

NPI Number	:	1649836081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISSADA SCOTT VARNER DC

Provider Business Mailing Address
First Line	:	4937 GRAZIANO AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89141-3890
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3047 S DECATUR BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-7144
Country	:	US
Telephone Number	:	702-222-3288
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2019
Last Update Date	:	05/10/2019

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