Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | B01795 | NV |
NPI | 1003458639 |
---|---|
Provider Name | Dr. Richard Hoani Kanani Poulsen |
First Address | Las Vegas, NV 89117-4104 |
Second Address | Las Vegas, NV 89117-4104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2019 |
Last Update Date | 15/10/2019 |