Provider Demographics
NPI:1346379377
Name:ACHAVAL, ALBERTO EDGARDO (DC)
Entity Type:Individual
Prefix:
First Name:ALBERTO
Middle Name:EDGARDO
Last Name:ACHAVAL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 E CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-1572
Mailing Address - Country:US
Mailing Address - Phone:702-388-4048
Mailing Address - Fax:702-382-8191
Practice Address - Street 1:830 E CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-1572
Practice Address - Country:US
Practice Address - Phone:702-388-4048
Practice Address - Fax:702-382-8191
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB-586111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor