1386816676 NPI number — ARMINAS WAGNER ENTERPRISES

Table of content: (NPI 1386816676)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386816676 NPI number — ARMINAS WAGNER ENTERPRISES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARMINAS WAGNER ENTERPRISES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NEVADA CHIROPRACTIC REHABILITATION CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386816676
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
02/25/2009
NPI Reactivation Date:
01/11/2010

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3900 W CHARLESTON BLVD
Provider Second Line Business Mailing Address:
SUITE 140
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89102-1628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-310-5528
Provider Business Mailing Address Fax Number:
702-310-5549

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3900 W CHARLESTON BLVD
Provider Second Line Business Practice Location Address:
SUITE 140
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89102-1628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-310-5528
Provider Business Practice Location Address Fax Number:
702-310-5549
Provider Enumeration Date:
03/27/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WAGNER
Authorized Official First Name:
ARMINAS
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
DR./OWNER
Authorized Official Telephone Number:
702-310-5528

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  B00777 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 101115 . This is a "MEDICARE GROUP PIN NUMBER" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: 1659438232 . This is a "TYPE 1 NPI NUMBER" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".




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