Provider Demographics
NPI:1730352618
Name:SPRING MOUNTAIN CHIROPRACTIC AND REHABILITATION
Entity type:Organization
Organization Name:SPRING MOUNTAIN CHIROPRACTIC AND REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:ROLAND
Authorized Official - Last Name:FOREMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:775-537-6110
Mailing Address - Street 1:2080 E CALVADA BLVD # 100
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89048-5844
Mailing Address - Country:US
Mailing Address - Phone:775-537-6110
Mailing Address - Fax:775-537-6151
Practice Address - Street 1:2080 E CALVADA BLVD # 100
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-5844
Practice Address - Country:US
Practice Address - Phone:775-537-6110
Practice Address - Fax:775-537-6151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB00810111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty