Provider Demographics
NPI:1760661680
Name:NELLIS CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:NELLIS CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:GROVE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:702-438-8383
Mailing Address - Street 1:2875 S NELLIS BLVD
Mailing Address - Street 2:STE. A-7
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-2086
Mailing Address - Country:US
Mailing Address - Phone:702-438-8383
Mailing Address - Fax:702-438-9014
Practice Address - Street 1:2875 S NELLIS BLVD
Practice Address - Street 2:STE. A-7
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-2086
Practice Address - Country:US
Practice Address - Phone:702-438-8383
Practice Address - Fax:702-438-9014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB00840111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVU87874Medicare UPIN