Provider Demographics
NPI:1770653255
Name:ADVANCED CHIROPRACTIC ORTHOPEDICS
Entity Type:Organization
Organization Name:ADVANCED CHIROPRACTIC ORTHOPEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES SEC
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:702-240-0520
Mailing Address - Street 1:6837 W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-1635
Mailing Address - Country:US
Mailing Address - Phone:702-240-0520
Mailing Address - Fax:702-240-2072
Practice Address - Street 1:6837 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1635
Practice Address - Country:US
Practice Address - Phone:702-240-0520
Practice Address - Fax:702-240-2072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB00386111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVU34000Medicare UPIN
NVDC386Medicare ID - Type Unspecified