Provider Demographics
NPI:1205382579
Name:CHIROPRACTED LLC
Entity Type:Organization
Organization Name:CHIROPRACTED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:TEDDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-357-0216
Mailing Address - Street 1:8560 SOUTH EASTERN AVE SUITE 150
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8560 S EASTERN AVE STE 150
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-2848
Practice Address - Country:US
Practice Address - Phone:702-357-0216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty