Provider Demographics
NPI:1518189737
Name:SOUTHISENE, THONGXAY (DC)
Entity Type:Individual
Prefix:DR
First Name:THONGXAY
Middle Name:
Last Name:SOUTHISENE
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 1:6844 PHILIPPE ALLEN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-5240
Mailing Address - Country:US
Mailing Address - Phone:702-339-4537
Mailing Address - Fax:
Practice Address - Street 1:1928 E SAHARA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-3843
Practice Address - Country:US
Practice Address - Phone:702-457-4727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVC04-00296-J-094813111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor