Provider Demographics
NPI:1427009042
Name:MOUNTAIN WEST CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:MOUNTAIN WEST CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:SIMONCELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:702-256-8686
Mailing Address - Street 1:9030 W SAHARA AVE
Mailing Address - Street 2:SUITE 1290
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-5744
Mailing Address - Country:US
Mailing Address - Phone:702-256-8686
Mailing Address - Fax:702-256-2206
Practice Address - Street 1:9034 W SAHARA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-5744
Practice Address - Country:US
Practice Address - Phone:702-256-8686
Practice Address - Fax:702-256-2206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB458111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1730390964OtherDR. ERIC J HOMA
NV102257Medicare PIN