Provider Demographics
NPI:1992812689
Name:HIDALGO, JAMES R (DC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:HIDALGO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8821 W SAHARA AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-5893
Mailing Address - Country:US
Mailing Address - Phone:702-876-3300
Mailing Address - Fax:702-876-3174
Practice Address - Street 1:8821 W SAHARA AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2751
Practice Address - Country:US
Practice Address - Phone:702-876-3300
Practice Address - Fax:702-876-3174
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NVB00323111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV104658Medicare PIN