Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | B01376 | NV |
NPI | 1407186455 |
---|---|
Provider Name | Chad Wiberg |
First Address | Las Vegas, NV 89120-3218 |
Second Address | Las Vegas, NV 89120-3218 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2010 |
Last Update Date | 13/01/2010 |