Provider Demographics
NPI:1659795482
Name:SUNDANCE CHIROPRACTIC
Entity Type:Organization
Organization Name:SUNDANCE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:702-735-7246
Mailing Address - Street 1:3315 W CRAIG RD STE 105
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-5001
Mailing Address - Country:US
Mailing Address - Phone:702-735-7246
Mailing Address - Fax:702-489-7556
Practice Address - Street 1:3315 W CRAIG RD STE 105
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-5001
Practice Address - Country:US
Practice Address - Phone:702-735-7246
Practice Address - Fax:702-489-7556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-14
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB00739111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty