Provider Demographics
NPI:1912182866
Name:R SCOTT ICKES DC INC
Entity Type:Organization
Organization Name:R SCOTT ICKES DC INC
Other - Org Name:ADVANTAGE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:ICKES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:702-614-9500
Mailing Address - Street 1:55 S VALLE VERDE DR STE 450
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-3110
Mailing Address - Country:US
Mailing Address - Phone:702-614-9500
Mailing Address - Fax:702-614-9505
Practice Address - Street 1:55 S VALLE VERDE DR STE 450
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-3110
Practice Address - Country:US
Practice Address - Phone:702-614-9500
Practice Address - Fax:702-614-9505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB725111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty