MEDICARE: ANDREI RAZSADIN DC DOCTOR OF CHIROPR

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	DC26236	CA
2	111N00000X	Chiropractor	B-773	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881708675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREI RAZSADIN DC DOCTOR OF CHIROPR

Provider Business Mailing Address
First Line	:	3376 S EASTERN AVE
Second Line	:	#160
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-3380
Country	:	US
Telephone Number	:	702-369-5436
Fax Number	:	702-650-2404

Provider Business Practice Location Address
First Line	:	3376 S EASTERN AVE
Second Line	:	#160
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-3380
Country	:	US
Telephone Number	:	702-369-5436
Fax Number	:	702-650-2404

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

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	06/25/2010

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