Provider Demographics
NPI:1528192283
Name:FIFE, BRIAN K (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:K
Last Name:FIFE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4116 W CRAIG RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-2732
Mailing Address - Country:US
Mailing Address - Phone:702-655-1199
Mailing Address - Fax:702-646-0630
Practice Address - Street 1:4116 W CRAIG RD
Practice Address - Street 2:SUITE 100
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-2732
Practice Address - Country:US
Practice Address - Phone:702-655-1199
Practice Address - Fax:702-646-0630
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB00612111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV34029Medicare ID - Type Unspecified