Provider Demographics
NPI:1295774263
Name:ADVANCED SPINE & REHABILITATION LLC
Entity type:Organization
Organization Name:ADVANCED SPINE & REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:S
Authorized Official - Last Name:JANDA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-990-2225
Mailing Address - Street 1:715 MALL RING CIRCLE
Mailing Address - Street 2:#205
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-6667
Mailing Address - Country:US
Mailing Address - Phone:702-339-1142
Mailing Address - Fax:702-897-2896
Practice Address - Street 1:715 MALL RING CIRCLE
Practice Address - Street 2:#205
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-6667
Practice Address - Country:US
Practice Address - Phone:702-339-1142
Practice Address - Fax:702-897-2896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV102230Medicare ID - Type Unspecified