Provider Demographics
NPI:1174625917
Name:IAN K YAMANE DC PC
Entity type:Organization
Organization Name:IAN K YAMANE DC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:YAMANE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:702-309-4878
Mailing Address - Street 1:2851 N TENAYA WAY STE 205
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0453
Mailing Address - Country:US
Mailing Address - Phone:702-309-4878
Mailing Address - Fax:702-658-7117
Practice Address - Street 1:2851 N TENAYA WAY STE 205
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0453
Practice Address - Country:US
Practice Address - Phone:702-309-4878
Practice Address - Fax:702-658-7117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV36665Medicare ID - Type UnspecifiedGROUP NUMBER