Provider Demographics
NPI:1346674785
Name:CENTENNIAL WELLNESS CENTER
Entity Type:Organization
Organization Name:CENTENNIAL WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUDA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:702-458-2225
Mailing Address - Street 1:7910 W TROPICAL PKWY
Mailing Address - Street 2:STE. 110
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-4554
Mailing Address - Country:US
Mailing Address - Phone:702-458-2225
Mailing Address - Fax:702-396-4536
Practice Address - Street 1:7910 W TROPICAL PKWY
Practice Address - Street 2:STE. 110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4554
Practice Address - Country:US
Practice Address - Phone:702-458-2225
Practice Address - Fax:702-396-4536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB00803111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty