Provider Demographics
NPI:1497183768
Name:IDEAL CHIROPRACTIC
Entity type:Organization
Organization Name:IDEAL CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:INSERA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:702-617-8676
Mailing Address - Street 1:10624 S EASTERN AVE STE Q
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2975
Mailing Address - Country:US
Mailing Address - Phone:702-617-8676
Mailing Address - Fax:702-617-8678
Practice Address - Street 1:10624 S EASTERN AVE STE Q
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2975
Practice Address - Country:US
Practice Address - Phone:702-617-8676
Practice Address - Fax:702-617-8678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-24
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB788111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV32939Medicare PIN