MEDICARE: DR. SAM DOMINIC COLARUSSO 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
1	111NI0013X	Independent Medical Examiner Chiropractor	B610	NV

General Provider Information

NPI Number	:	1992867287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAM DOMINIC COLARUSSO D.C.

Provider Business Mailing Address
First Line	:	7380 W SAHARA AVE
Second Line	:	SUITE 100
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-2760
Country	:	US
Telephone Number	:	702-252-7246
Fax Number	:	702-251-9650

Provider Business Practice Location Address
First Line	:	7220 S CIMARRON RD STE 150
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-2170
Country	:	US
Telephone Number	:	702-944-2225
Fax Number	:	702-655-2346

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

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	07/21/2022

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