Healthcare Provider Details

I. General information

NPI: 1326311093
Provider Name (Legal Business Name): FUST CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2012
Last Update Date: 02/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3663 E SUNSET RD SUITE 503
LAS VEGAS NV
89120-3218
US

IV. Provider business mailing address

3663 E SUNSET RD SUITE 503
LAS VEGAS NV
89120-3218
US

V. Phone/Fax

Practice location:
  • Phone: 702-434-2800
  • Fax: 702-451-1034
Mailing address:
  • Phone: 702-434-2800
  • Fax: 702-451-1034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number1710
License Number StateNV

VIII. Authorized Official

Name: KENNETH FUST
Title or Position: MANAGER
Credential: D.C.
Phone: 702-434-2800