Provider Demographics
NPI:1326311093
Name:FUST CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:FUST CHIROPRACTIC PLLC
Other - Org Name:GREEN VALLEY NECK AND BACK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:FUST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:702-434-2800
Mailing Address - Street 1:3663 E SUNSET RD
Mailing Address - Street 2:SUITE 503
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-3218
Mailing Address - Country:US
Mailing Address - Phone:702-434-2800
Mailing Address - Fax:702-451-1034
Practice Address - Street 1:3663 E SUNSET RD
Practice Address - Street 2:SUITE 503
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3218
Practice Address - Country:US
Practice Address - Phone:702-434-2800
Practice Address - Fax:702-451-1034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X
NV1710261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty