Provider Demographics
NPI:1275027229
Name:HALO CHIROPRACTIC WELLNESS CLINIC & PERFORMANCE CENTER
Entity Type:Organization
Organization Name:HALO CHIROPRACTIC WELLNESS CLINIC & PERFORMANCE CENTER
Other - Org Name:HALO CHIROPRACTIC WELLNESS CLINIC & PERFORMANCE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FIDEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ODUNUGA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:702-510-4881
Mailing Address - Street 1:8930 W SUNSET RD STE 350
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5042
Mailing Address - Country:US
Mailing Address - Phone:702-917-1716
Mailing Address - Fax:
Practice Address - Street 1:8930 W SUNSET RD STE 350
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5042
Practice Address - Country:US
Practice Address - Phone:702-917-1716
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01519261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service