Provider Demographics
NPI:1841628492
Name:MOUNTAIN WEST CHIROPRACTIC OF GREEN VALLEY
Entity type:Organization
Organization Name:MOUNTAIN WEST CHIROPRACTIC OF GREEN VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEVON
Authorized Official - Middle Name:M
Authorized Official - Last Name:NISSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-263-4925
Mailing Address - Street 1:321 N PECOS RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-1347
Mailing Address - Country:US
Mailing Address - Phone:702-263-4925
Mailing Address - Fax:702-263-6874
Practice Address - Street 1:321 N PECOS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-1347
Practice Address - Country:US
Practice Address - Phone:702-263-4925
Practice Address - Fax:702-263-6874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-17
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty