Provider Demographics
NPI:1528140118
Name:COMMUNITY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:COMMUNITY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARYANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:EATON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:702-898-4600
Mailing Address - Street 1:6525 N BUFFALO DR
Mailing Address - Street 2:160
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-4040
Mailing Address - Country:US
Mailing Address - Phone:702-898-4600
Mailing Address - Fax:702-395-0435
Practice Address - Street 1:6525 N BUFFALO DR
Practice Address - Street 2:160
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-4040
Practice Address - Country:US
Practice Address - Phone:702-898-4600
Practice Address - Fax:702-395-0435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01181111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty