Provider Demographics
NPI:1770526055
Name:JARRETT, H GREGORY (DC)
Entity type:Individual
Prefix:
First Name:H
Middle Name:GREGORY
Last Name:JARRETT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4045 S BUFFALO DRIVE
Mailing Address - Street 2:STE A101-172
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147
Mailing Address - Country:US
Mailing Address - Phone:702-878-8252
Mailing Address - Fax:702-878-9096
Practice Address - Street 1:600 S RANCHO DRIVE
Practice Address - Street 2:STE 113
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106
Practice Address - Country:US
Practice Address - Phone:702-878-8252
Practice Address - Fax:702-878-9096
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB00210111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100794OtherGROUP
NVT67251Medicare PIN
NV100794Medicare UPIN
T67251Medicare UPIN