MEDICARE: FIRST CHOICE 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	B00531	NV

General Provider Information

NPI Number	:	1902091747
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST CHOICE CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	5642 S EASTERN AVE
Second Line	:	SUITE C
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-2310
Country	:	US
Telephone Number	:	702-736-8535
Fax Number	:	702-736-8520

Provider Business Practice Location Address
First Line	:	5642 S EASTERN AVE
Second Line	:	SUITE C
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-2310
Country	:	US
Telephone Number	:	702-736-8535
Fax Number	:	702-736-8520

Authorized Official
Title or Position	:	MANAGER DOCTOR
Name	:	JAMES G SPICKELMIER
Credential	:	DC
Telephone Number	:	702-736-8535

Provider Enumeration Date	:	09/13/2007
Last Update Date	:	09/13/2007

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Directions to “FIRST CHOICE CHIROPRACTIC LLC ” Practice Location

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