Provider Demographics
NPI:1194226829
Name:THE SPINE, DISC & NERVE DOCTOR, INC.
Entity Type:Organization
Organization Name:THE SPINE, DISC & NERVE DOCTOR, INC.
Other - Org Name:THE SPINE DISC & NERVE DOCTOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, OWNER & OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:RE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:702-448-4566
Mailing Address - Street 1:PO BOX 336543
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89033-6543
Mailing Address - Country:US
Mailing Address - Phone:702-448-4566
Mailing Address - Fax:
Practice Address - Street 1:3940 N MLK BLVD STE 107
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-6607
Practice Address - Country:US
Practice Address - Phone:702-448-4566
Practice Address - Fax:725-605-3464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01660111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty