Provider Demographics
NPI:1083633051
Name:ADVANCED SPINE & REHABILITATION, LLC
Entity Type:Organization
Organization Name:ADVANCED SPINE & REHABILITATION, LLC
Other - Org Name:ADVANCED SPINE & REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:S
Authorized Official - Last Name:JANDA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:702-990-2225
Mailing Address - Street 1:715 MALL RING CIR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-6665
Mailing Address - Country:US
Mailing Address - Phone:702-990-2225
Mailing Address - Fax:702-990-7711
Practice Address - Street 1:715 MALL RING CIR
Practice Address - Street 2:SUITE 205
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-6665
Practice Address - Country:US
Practice Address - Phone:702-990-2225
Practice Address - Fax:702-990-7711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV102230Medicare ID - Type Unspecified