Provider Demographics
NPI:1831369933
Name:DECATUR & CRAIG CHIROPRACTIC
Entity type:Organization
Organization Name:DECATUR & CRAIG CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICKE
Authorized Official - Middle Name:W
Authorized Official - Last Name:HALLGREN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:702-656-7460
Mailing Address - Street 1:4925 W CRAIG RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-2730
Mailing Address - Country:US
Mailing Address - Phone:702-656-7460
Mailing Address - Fax:702-656-7461
Practice Address - Street 1:4925 W CRAIG RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-2730
Practice Address - Country:US
Practice Address - Phone:702-656-7460
Practice Address - Fax:702-656-7461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB519111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1093704421OtherNPI INDIVIDUAL
NV1093704421OtherNPI INDIVIDUAL
NVU40152Medicare UPIN