Provider Demographics
NPI:1750331013
Name:BRUCE E MULLEN A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:BRUCE E MULLEN A PROFESSIONAL CORPORATION
Other - Org Name:SPINECARE AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-883-7938
Mailing Address - Street 1:755 N ROOP ST STE 112
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-3107
Mailing Address - Country:US
Mailing Address - Phone:775-883-7938
Mailing Address - Fax:775-883-0907
Practice Address - Street 1:755 N ROOP ST STE 112
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-3107
Practice Address - Country:US
Practice Address - Phone:775-883-7938
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100505821Medicaid
NV100505821Medicaid