Pac Chiropractic LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

B895 Issued in NV

Legal business name

PAC CHIROPRACTIC LLC

Practice address

204 W Pacific Ave
Henderson, NV 89015-7376

Phone

(702) 856-0665

Fax

(702) 675-8239

NPI assigned

Apr 3, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Mary C Heinrich

Title

Office Manager

Phone

(702) 856-0665

Specialties & licenses 1

Addresses

Other identifiers 5

Other names 1

• PACIFIC CHIROPRACTIC Former legal business name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1364947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1396742400000",
    "number": "1437492899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 230819",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891050819",
            "telephone_number": "702-856-0665",
            "fax_number": "702-675-8239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 W PACIFIC AVE",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890157376",
            "telephone_number": "702-856-0665",
            "fax_number": "702-675-8239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAC CHIROPRACTIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-03",
        "last_updated": "2014-04-06",
        "status": "A",
        "authorized_official_last_name": "HEINRICH",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "702-856-0665",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "NV",
            "license": "B895",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "350054434",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003602035",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11384445",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "CC3751",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7835292",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PACIFIC CHIROPRACTIC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Chiropractor in Henderson, NV
• Providers in Henderson, NV by specialty
• Chiropractor in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.