Provider Demographics
NPI:1619144573
Name:MEDICAL CHIROPRACTIC HOSPITAL
Entity Type:Organization
Organization Name:MEDICAL CHIROPRACTIC HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:702-873-8199
Mailing Address - Street 1:8515 EDNA AVE STE 280
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-4442
Mailing Address - Country:US
Mailing Address - Phone:702-405-8189
Mailing Address - Fax:
Practice Address - Street 1:8515 EDNA AVE STE 280
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-4442
Practice Address - Country:US
Practice Address - Phone:702-873-8199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes284300000XHospitalsSpecial HospitalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVBR827AMedicare UPIN