Provider Demographics
NPI:1437492899
Name:PAC CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:PAC CHIROPRACTIC LLC
Other - Org Name:PACIFIC CHIROPRACTIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:HEINRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-856-0665
Mailing Address - Street 1:PO BOX 230819
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89105-0819
Mailing Address - Country:US
Mailing Address - Phone:702-856-0665
Mailing Address - Fax:702-675-8239
Practice Address - Street 1:204 W PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-7376
Practice Address - Country:US
Practice Address - Phone:702-856-0665
Practice Address - Fax:702-675-8239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-03
Last Update Date:2014-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB895111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV350054434OtherRAILROAD MEDICARE
NV003602035Medicaid
NV11384445OtherCAQH
NVCC3751OtherBLUE CROSS/BLUE SHIELD
NV7835292OtherAETNA
NVCC3751OtherBLUE CROSS/BLUE SHIELD