Provider Demographics
NPI:1891850459
Name:HERMANSEN, DOUGLAS B (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:B
Last Name:HERMANSEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3551 E BONANZA RD
Mailing Address - Street 2:#108
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-2198
Mailing Address - Country:US
Mailing Address - Phone:702-437-0800
Mailing Address - Fax:702-437-7857
Practice Address - Street 1:3551 E BONANZA RD
Practice Address - Street 2:#108
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-2198
Practice Address - Country:US
Practice Address - Phone:702-437-0800
Practice Address - Fax:702-437-7857
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB498111N00000X
NVB498 295368-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1891850459OtherNPI #
NV100509349OtherMEDICAID GROUP #
V100640OtherMEDICARE GROUP #
1497873475OtherNPI GROUP #
V100646Medicare PIN