Provider Demographics
NPI:1073631693
Name:VILLASENOR, ISRAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:ISRAEL
Middle Name:
Last Name:VILLASENOR
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E HORIZON DR STE A
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-8031
Mailing Address - Country:US
Mailing Address - Phone:702-568-8450
Mailing Address - Fax:702-568-8451
Practice Address - Street 1:270 E HORIZON DR STE 109
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-8037
Practice Address - Country:US
Practice Address - Phone:702-568-8450
Practice Address - Fax:702-568-8451
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB797111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV106105Medicare PIN
NV6092520001Medicare NSC