Provider Demographics
NPI:1992867287
Name:COLARUSSO, SAM DOMINIC (DC)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:DOMINIC
Last Name:COLARUSSO
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 1:7380 W SAHARA AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2760
Mailing Address - Country:US
Mailing Address - Phone:702-252-7246
Mailing Address - Fax:702-251-9650
Practice Address - Street 1:7220 S CIMARRON RD STE 150
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-2170
Practice Address - Country:US
Practice Address - Phone:702-944-2225
Practice Address - Fax:702-655-2346
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB610111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner