Provider Demographics
NPI:1962606814
Name:BRIM, ROLAND KEITH (DC)
Entity type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:KEITH
Last Name:BRIM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 PASEO DEL PRADO STE B304
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-4335
Mailing Address - Country:US
Mailing Address - Phone:702-479-6650
Mailing Address - Fax:702-938-9066
Practice Address - Street 1:2320 PASEO DEL PRADO
Practice Address - Street 2:STE B304
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-4335
Practice Address - Country:US
Practice Address - Phone:760-948-4870
Practice Address - Fax:760-948-9612
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01525111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor