Provider Demographics
NPI:1053694398
Name:LAS VEGAS NECK AND BACK SOLUTIONS LLC
Entity type:Organization
Organization Name:LAS VEGAS NECK AND BACK SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ISRAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLASENOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:702-568-8450
Mailing Address - Street 1:200 E HORIZON DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-8033
Mailing Address - Country:US
Mailing Address - Phone:702-568-8450
Mailing Address - Fax:702-568-8451
Practice Address - Street 1:200 E HORIZON DR
Practice Address - Street 2:SUITE A
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-8033
Practice Address - Country:US
Practice Address - Phone:702-568-8450
Practice Address - Fax:702-568-8451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-22
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB-797111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV32969Medicare UPIN