MEDICARE: OBRIEN CHIROPRACTIC PLLC

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	B01292	NV

General Provider Information

NPI Number	:	1679705172
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OBRIEN CHIROPRACTIC PLLC

Provider Business Mailing Address
First Line	:	6015 S FORT APACHE RD
Second Line	:	SUITE 180
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5543
Country	:	US
Telephone Number	:	702-739-6984
Fax Number	:	702-739-6904

Provider Business Practice Location Address
First Line	:	6015 S FORT APACHE RD
Second Line	:	SUITE 180
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5543
Country	:	US
Telephone Number	:	702-739-6984
Fax Number	:	702-739-6904

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JASON THOMAS O'BRIEN
Credential	:	D.C.
Telephone Number	:	702-739-6984

Provider Enumeration Date	:	08/17/2009
Last Update Date	:	08/17/2009

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