Healthcare Provider Details

I. General information

NPI: 1659362747
Provider Name (Legal Business Name): STEPHEN FAIR DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2005
Last Update Date: 11/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 S 7TH STREET
LAS VEGAS NV
89101
US

IV. Provider business mailing address

10120 W FLAMINGO RD #4-265
LAS VEGAS NV
89147
US

V. Phone/Fax

Practice location:
  • Phone: 702-256-8080
  • Fax: 702-256-8081
Mailing address:
  • Phone: 702-256-8080
  • Fax: 702-256-8081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberB00922
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: