MEDICARE: BACK 2 RELIEF VEGAS INC

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	111NR0400X	Rehabilitation Chiropractor

General Provider Information

NPI Number	:	1831736693
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACK 2 RELIEF VEGAS INC

Provider Business Mailing Address
First Line	:	PO BOX 971532
Second Line	:
City	:	OREM
State	:	UT
Zip	:	84097-1532
Country	:	US
Telephone Number	:	801-319-1120
Fax Number	:	888-509-2322

Provider Business Practice Location Address
First Line	:	3455 E LAKE MEAD BLVD STE 1
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-7328
Country	:	US
Telephone Number	:	702-642-1300
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. RODOLFO MARTINEZ-FERRATE
Credential	:	MD
Telephone Number	:	801-651-4283

Provider Enumeration Date	:	11/28/2019
Last Update Date	:	11/28/2019

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Directions to “BACK 2 RELIEF VEGAS INC ” Practice Location

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