Provider Demographics
NPI:1558560334
Name:CENTRAL PARC LTD
Entity Type:Organization
Organization Name:CENTRAL PARC LTD
Other - Org Name:SPINAL REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:JAGET
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:702-255-1616
Mailing Address - Street 1:8440 W LAKE MEAD BLVD
Mailing Address - Street 2:#101
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128
Mailing Address - Country:US
Mailing Address - Phone:702-255-1616
Mailing Address - Fax:702-255-5393
Practice Address - Street 1:8440 W LAKE MEAD BLVD
Practice Address - Street 2:#101
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128
Practice Address - Country:US
Practice Address - Phone:702-255-1616
Practice Address - Fax:702-255-5393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV126595111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty