Provider Demographics
NPI:1841952884
Name:CRAFTED WELLNESS & SPORTS REHAB
Entity type:Organization
Organization Name:CRAFTED WELLNESS & SPORTS REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:702-467-8202
Mailing Address - Street 1:880 SEVEN HILLS DR STE 210
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4380
Mailing Address - Country:US
Mailing Address - Phone:725-219-0676
Mailing Address - Fax:725-219-0641
Practice Address - Street 1:880 SEVEN HILLS DR STE 210
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4380
Practice Address - Country:US
Practice Address - Phone:725-219-0676
Practice Address - Fax:725-219-0641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty