Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1033419627 |
---|---|
Provider Name | Kelvin D Chandler |
First Address | Las Vegas, NV 89117-1944 |
Second Address | Las Vegas, NV 89117-1944 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2010 |
Last Update Date | 28/10/2010 |