Provider Demographics
NPI:1205171105
Name:SIENA NECK AND BACK
Entity type:Organization
Organization Name:SIENA NECK AND BACK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:GAMETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:702-492-6325
Mailing Address - Street 1:2625 W HORIZON RIDGE PKWY STE 140
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2896
Mailing Address - Country:US
Mailing Address - Phone:702-492-6325
Mailing Address - Fax:702-492-0615
Practice Address - Street 1:2625 W HORIZON RIDGE PKWY STE 140
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2896
Practice Address - Country:US
Practice Address - Phone:702-492-6325
Practice Address - Fax:702-492-0615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U92040Medicare UPIN
V36816Medicare PIN