Provider Demographics
NPI:1649444597
Name:FLORENDO, JOHN G (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:G
Last Name:FLORENDO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6141 SOUTH RAINBOW BLVD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118
Mailing Address - Country:US
Mailing Address - Phone:702-357-1595
Mailing Address - Fax:
Practice Address - Street 1:6141 S RAINBOW BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-3261
Practice Address - Country:US
Practice Address - Phone:702-357-1595
Practice Address - Fax:702-920-6555
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVBO1239111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ589601Medicare PIN