Provider Demographics
NPI:1508987116
Name:DIRAIMONDO, MICHAEL FRANK (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:FRANK
Last Name:DIRAIMONDO
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 1:2411 W HORIZON RIDGE PKWY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5779
Mailing Address - Country:US
Mailing Address - Phone:702-452-2225
Mailing Address - Fax:
Practice Address - Street 1:2411 W HORIZON RIDGE PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5779
Practice Address - Country:US
Practice Address - Phone:702-452-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB948111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV37047Medicare ID - Type Unspecified
NVT18655Medicare UPIN