Provider Demographics
NPI:1326629627
Name:SCOLIOSIS BASICS, LLC
Entity Type:Organization
Organization Name:SCOLIOSIS BASICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:908-224-4252
Mailing Address - Street 1:8301 W FLAMINGO RD APT 1037
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-4137
Mailing Address - Country:US
Mailing Address - Phone:862-219-9847
Mailing Address - Fax:
Practice Address - Street 1:8301 W FLAMINGO RD APT 1037
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-4137
Practice Address - Country:US
Practice Address - Phone:862-219-9847
Practice Address - Fax:833-696-0789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No251E00000XAgenciesHome Health