Provider Demographics
NPI:1144343450
Name:LEADING EDGE CHIROPRACTIC, LTD.
Entity type:Organization
Organization Name:LEADING EDGE CHIROPRACTIC, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:775-284-4900
Mailing Address - Street 1:10635 PROFESSIONAL CIR STE B
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-5836
Mailing Address - Country:US
Mailing Address - Phone:775-284-4900
Mailing Address - Fax:775-284-4902
Practice Address - Street 1:10635 PROFESSIONAL CIR STE B
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-5836
Practice Address - Country:US
Practice Address - Phone:775-284-4900
Practice Address - Fax:775-284-4902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01030111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV00795Medicare UPIN
NVV39900Medicare PIN
NV6332800001Medicare NSC