Provider Demographics
NPI:1376696104
Name:LEAVITT, WILLIAM G (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:G
Last Name:LEAVITT
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 1:6819 W TROPICANA AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-4928
Mailing Address - Country:US
Mailing Address - Phone:702-364-5130
Mailing Address - Fax:702-364-5612
Practice Address - Street 1:6819 W TROPICANA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-4928
Practice Address - Country:US
Practice Address - Phone:702-364-5130
Practice Address - Fax:702-364-5612
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB00455111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVDC455BMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NVU25832Medicare UPIN