Basic Information
| Provider Information | |||||||||
| NPI: | 1134281413 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NOZAWA | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | KEI | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7250 PEAK DR | ||||||||
| Address2: | STE 100 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891289028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023864700 | ||||||||
| FaxNumber: | 7023864701 | ||||||||
| Practice Location | |||||||||
| Address1: | 7220 S CIMARRON RD | ||||||||
| Address2: | SUITE 270 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891132159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026235564 | ||||||||
| FaxNumber: | 7023864701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2006 | ||||||||
| LastUpdateDate: | 07/27/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | B673 | NV | Y | Chiropractic Providers | Chiropractor |
ID Information
| ID | Type | State | Issuer | Description | V111805 | 01 | NV | MEDICARE PTAN | OTHER |