Provider Demographics
NPI:1154591956
Name:CANYON CHIROPRACTIC CLINIC, INC
Entity type:Organization
Organization Name:CANYON CHIROPRACTIC CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:KING
Authorized Official - Last Name:MAHLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:775-787-2225
Mailing Address - Street 1:PO BOX 34855
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89533-4855
Mailing Address - Country:US
Mailing Address - Phone:775-787-2225
Mailing Address - Fax:775-787-2282
Practice Address - Street 1:2005 SIERRA HIGHLANDS DR
Practice Address - Street 2:SUITE 147
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523-2303
Practice Address - Country:US
Practice Address - Phone:775-787-2225
Practice Address - Fax:775-787-2282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB537111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV34806Medicare PIN