Provider Demographics
NPI:1518175363
Name:NOWAKOWSKI & JOHNSON, INC
Entity Type:Organization
Organization Name:NOWAKOWSKI & JOHNSON, INC
Other - Org Name:SPINE WELLNESS CENTER OF SOUTHERN NEVADA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:MS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:702-433-8333
Mailing Address - Street 1:3085 E RUSSELL RD
Mailing Address - Street 2:STE E
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-3473
Mailing Address - Country:US
Mailing Address - Phone:702-433-8333
Mailing Address - Fax:702-433-4632
Practice Address - Street 1:3085 E RUSSELL RD
Practice Address - Street 2:STE E
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3473
Practice Address - Country:US
Practice Address - Phone:702-433-8333
Practice Address - Fax:702-433-4632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV B 928111N00000X, 111NI0013X
NVNV B 935111N00000X, 111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV36495Medicare ID - Type UnspecifiedGROUP MEDICARE