Healthcare Provider Details

I. General information

NPI: 1457532244
Provider Name (Legal Business Name): STEPHEN L. FAIR, D.C., LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 11/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N RAINBOW BLVD SUITE 115
LAS VEGAS NV
89107-1082
US

IV. Provider business mailing address

500 N RAINBOW BLVD SUITE 115
LAS VEGAS NV
89107-1082
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 Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberB00922
License Number StateNV

VIII. Authorized Official

Name: BARRIE J MINADEO KNUTSON
Title or Position: OFFICE MANAGER
Credential: CMA-A
Phone: 702-256-8080