Provider Demographics
NPI:1023297058
Name:COLARUSSO AND NOZAWA LTD
Entity type:Organization
Organization Name:COLARUSSO AND NOZAWA LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:NOZAWA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:702-944-2225
Mailing Address - Street 1:3417 WHITE BARK PINE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-8119
Mailing Address - Country:US
Mailing Address - Phone:702-254-2225
Mailing Address - Fax:
Practice Address - Street 1:6015 S FORT APACHE RD
Practice Address - Street 2:STE 180
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5543
Practice Address - Country:US
Practice Address - Phone:702-944-2225
Practice Address - Fax:702-926-5560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB673111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV34080Medicare UPIN