Active NPI
Bruce C Koelliker, DC
- Chiropractor
- Las Vegas, NV
National Provider Identifier
1902902539
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- B646
- Practice address
- 9775 S Maryland Pkwy
Ste a
Las Vegas, NV 89183 - Phone
- (702) 837-0392
- Fax
- (702) 320-4148
- NPI assigned
- Sep 14, 2006
- Sex
- Male
- Sole proprietor
- No
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 | B646 | NV | Primary |
Addresses
Primary practice location
9775 S Maryland Pkwy
Ste a
Las Vegas, NV 89183
Mailing address
9775 S Maryland Parkway
Suite a
Las Vegas, NV 89183
Phone (702) 837-0392
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in UT
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Los Angeles College of Chiropractic, 1995
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1878 W 3600
West Valley, UT 84119-3893
Phone (801) 972-1222
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| B646 | NV | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Peterson Chiropractic | Chiropractor | Past | Accepting new patients |
| Daniel W Schultz DC PC | Chiropractor | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Chiropractor
- West Valley City, UT
- NPI 1134333669
-
- Chiropractor
- West Valley, UT
- NPI 1558631531
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1200614400000",
"number": "1902902539",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9775 S MARYLAND PARKWAY",
"address_2": "SUITE A",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "89183",
"telephone_number": "702-837-0392",
"fax_number": "702-320-4148"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9775 S MARYLAND PKWY",
"address_2": "STE A",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "89183",
"telephone_number": "702-837-0392",
"fax_number": "702-320-4148"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOELLIKER",
"first_name": "BRUCE",
"middle_name": "C",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-14",
"last_updated": "2008-01-18",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "NV",
"license": "B646",
"primary": true
}
],
"identifiers": [],
"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 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.