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General NPI Number Information
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NPI Number | 1326311093
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Entity Type | Organization
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Legal Business Name | FUST CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 02/10/2012
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Last Update Date | 02/10/2012
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Provider Practice Location Address
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Address Line | 3663 E SUNSET RD SUITE 503
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City | LAS VEGAS
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State | NV
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Zip | 89120-3218
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Country | US
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Telephone | 702-434-2800
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Fax | 702-451-1034
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Provider Business Mailing Address
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Address Line | 3663 E SUNSET RD SUITE 503
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City | LAS VEGAS
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State | NV
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Zip | 89120-3218
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Country | US
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Telephone | 702-434-2800
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Fax | 702-451-1034
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Authorized Official
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Title or Position | MANAGER
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Name | KENNETH FUST
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Credential | D.C.
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Telephone | 702-434-2800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 1710
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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