MEDICARE: RED ROCK CHIRO 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	:	1912640624
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RED ROCK CHIRO LLC

Provider Business Mailing Address
First Line	:	2085 VILLAGE CENTER CIR STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-6263
Country	:	US
Telephone Number	:	702-880-5335
Fax Number	:	702-880-5336

Provider Business Practice Location Address
First Line	:	2085 VILLAGE CENTER CIR STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-6263
Country	:	US
Telephone Number	:	702-880-5335
Fax Number	:	702-880-5336

Authorized Official
Title or Position	:	OWNER
Name	:	MARGARET R COLUCCI
Credential	:	D.C.
Telephone Number	:	702-880-5335

Provider Enumeration Date	:	04/20/2022
Last Update Date	:	04/20/2022

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Directions to “RED ROCK CHIRO LLC ” Practice Location

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