Provider Demographics
NPI:1952855660
Name:DURSO CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:DURSO CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:DURSO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:702-608-3362
Mailing Address - Street 1:6730 MONTEZUMA CASTLE LN
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-1229
Mailing Address - Country:US
Mailing Address - Phone:321-917-4413
Mailing Address - Fax:
Practice Address - Street 1:6462 LOSEE RD
Practice Address - Street 2:STE 135
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89086-0103
Practice Address - Country:US
Practice Address - Phone:702-608-3362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB-01476111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty