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NPI Code Detail

MEDICARE: LEO F BLACK JR. D.C.

MEDICARE: LEO F BLACK JR. D.C.
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
1111N00000XChiropractorB355NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PIN#V38138OTHERNVLEO BLACK, DC

General Provider Information

NPI Number : 1922080019
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEO F BLACK JR. D.C.
Provider Business Mailing Address
First Line : 1301 BERTHA HOWE AVE
Second Line : SUITE 1
City : MESQUITE
State : NV
Zip : 89027-7502
Country : US
Telephone Number : 702-346-0800
Fax Number : 702-346-0801
Provider Business Practice Location Address
First Line : 1301 BERTHA HOWE AVE
Second Line : SUITE 1
City : MESQUITE
State : NV
Zip : 89027-7502
Country : US
Telephone Number : 702-346-0800
Fax Number : 702-346-0801
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2005
Last Update Date : 07/09/2007

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Directions to “ LEO F BLACK JR. D.C.” Practice Location

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