Provider Demographics
NPI:1609291285
Name:HIGH DESERT FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:HIGH DESERT FAMILY CHIROPRACTIC, LLC
Other - Org Name:NAVERAN FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:LOW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:775-623-3200
Mailing Address - Street 1:3200 TRADERS WAY STE C
Mailing Address - Street 2:
Mailing Address - City:WINNEMUCCA
Mailing Address - State:NV
Mailing Address - Zip Code:89445-3683
Mailing Address - Country:US
Mailing Address - Phone:775-623-3200
Mailing Address - Fax:775-623-3299
Practice Address - Street 1:3200 TRADERS WAY STE C
Practice Address - Street 2:
Practice Address - City:WINNEMUCCA
Practice Address - State:NV
Practice Address - Zip Code:89445-3683
Practice Address - Country:US
Practice Address - Phone:775-623-3200
Practice Address - Fax:775-623-3299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01314111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVFV266AMedicare PIN