Healthcare Provider Details

I. General information

NPI: 1447524855
Provider Name (Legal Business Name): KEVIN THOMAS BAHOORA ADVANCED SPINE AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2012
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7035 W. ANN RD #160
LAS VEGAS NV
89130-3868
US

IV. Provider business mailing address

7035 W. ANN RD #160
LAS VEGAS NV
89130-3868
US

V. Phone/Fax

Practice location:
  • Phone: 702-396-0277
  • Fax: 702-396-3790
Mailing address:
  • Phone: 702-396-0277
  • Fax: 702-396-3790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberB-799
License Number StateNV

VIII. Authorized Official

Name: KEVEN THOMAS BAHOORA
Title or Position: CHIROPRACTIC PHYSICIAN/OWNER/PRES
Credential: D.C.
Phone: 702-396-0277