Provider Demographics
NPI:1295905339
Name:SUMMERLIN CHIROPRACTIC INC,
Entity type:Organization
Organization Name:SUMMERLIN CHIROPRACTIC INC,
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:R
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:702-731-1200
Mailing Address - Street 1:8785 W WARM SPRINGS RD STE 109
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1824
Mailing Address - Country:US
Mailing Address - Phone:702-731-1200
Mailing Address - Fax:702-736-6302
Practice Address - Street 1:8785 W. WARM SPRINGS RD.
Practice Address - Street 2:SUITE 109
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148
Practice Address - Country:US
Practice Address - Phone:702-731-1200
Practice Address - Fax:702-736-6302
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMERLIN CHIROPRACTIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-05
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB1039302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV39007Medicare PIN