MEDICARE: INCLINE VILLAGE CHIROPRACTIC LLC

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

General Provider Information

NPI Number	:	1851925226
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INCLINE VILLAGE CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	894 SOUTHWOOD BLVD
Second Line	:
City	:	INCLINE VLG
State	:	NV
Zip	:	89451-9435
Country	:	US
Telephone Number	:	775-831-5544
Fax Number	:	775-831-5545

Provider Business Practice Location Address
First Line	:	894 SOUTHWOOD BLVD
Second Line	:
City	:	INCLINE VLG
State	:	NV
Zip	:	89451-9435
Country	:	US
Telephone Number	:	775-831-5544
Fax Number	:	775-831-5545

Authorized Official
Title or Position	:	AUTHORIZED OFFIFICAL
Name	:	EMMA GENEVIEVE FREEZE
Credential	:	D.C
Telephone Number	:	775-831-5544

Provider Enumeration Date	:	02/25/2020
Last Update Date	:	10/22/2024

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