MEDICARE: STEPHEN FAIR DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	B00922	NV

General Provider Information

NPI Number	:	1659362747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN FAIR DC

Provider Business Mailing Address
First Line	:	10120 W FLAMINGO RD #4-265
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147
Country	:	US
Telephone Number	:	702-256-8080
Fax Number	:	702-256-8081

Provider Business Practice Location Address
First Line	:	825 S 7TH STREET
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101
Country	:	US
Telephone Number	:	702-256-8080
Fax Number	:	702-256-8081

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/29/2005
Last Update Date	:	11/19/2014

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Directions to “ STEPHEN FAIR DC” Practice Location

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