Provider Demographics
NPI:1972876100
Name:PICKLE, FLP
Entity Type:Organization
Organization Name:PICKLE, FLP
Other - Org Name:LAS VEGAS ACCIDENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:G
Authorized Official - Last Name:JAGET
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:702-491-6762
Mailing Address - Street 1:2251 N RAMPART BLVD
Mailing Address - Street 2:163
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-7640
Mailing Address - Country:US
Mailing Address - Phone:702-491-6762
Mailing Address - Fax:702-548-4343
Practice Address - Street 1:501 S RANCHO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4828
Practice Address - Country:US
Practice Address - Phone:702-491-6762
Practice Address - Fax:702-548-4343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-19
Last Update Date:2012-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB00568111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty