Active NPI
Dale Allen Anderson, DC
- Chiropractor
- Las Vegas, NV
National Provider Identifier
1679557359
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- B119
- Practice address
- 2389 Renaissance Dr
Ste a
Las Vegas, NV 89119-6106 - Phone
- (702) 458-1495
- Fax
- (702) 458-7869
- NPI assigned
- Dec 6, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | B119 | NV | Primary |
Addresses
Primary practice location
2389 Renaissance Dr
Ste a
Las Vegas, NV 89119-6106
Mailing address
2389 Renaissance Dr
Ste a
Las Vegas, NV 89119-6106
Phone (702) 458-1495
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| VWJBJPO1 | Other | NV | MEDICARE PTAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| B119 | NV | MD | Chiropractor |
| 119 | NV | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133827200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1232496000000",
"number": "1679557359",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2389 RENAISSANCE DR",
"address_2": "STE A",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891196106",
"telephone_number": "702-458-1495",
"fax_number": "702-458-7869"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2389 RENAISSANCE DR",
"address_2": "STE A",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891196106",
"telephone_number": "702-458-1495",
"fax_number": "702-458-7869"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "DALE",
"middle_name": "ALLEN",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-12-06",
"last_updated": "2009-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "NV",
"license": "B119",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "VWJBJPO1",
"state": "NV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.