Provider Demographics
NPI:1558525501
Name:SIERRA CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:SIERRA CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:775-852-3333
Mailing Address - Street 1:3670 GRANT DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-5309
Mailing Address - Country:US
Mailing Address - Phone:775-852-3333
Mailing Address - Fax:775-322-0606
Practice Address - Street 1:3670 GRANT DR
Practice Address - Street 2:SUITE 101
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-5309
Practice Address - Country:US
Practice Address - Phone:775-852-3333
Practice Address - Fax:775-322-0606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB02006111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty