Provider Demographics
NPI:1174345433
Name:VAN NESS, DILLAN
Entity type:Individual
Prefix:
First Name:DILLAN
Middle Name:
Last Name:VAN NESS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8680 W WARM SPRINGS RD STE 155
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1828
Mailing Address - Country:US
Mailing Address - Phone:702-702-5446
Mailing Address - Fax:
Practice Address - Street 1:670 S GREEN VALLEY PKWY STE 150
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-0435
Practice Address - Country:US
Practice Address - Phone:702-293-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB02046111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor