Provider Demographics
NPI: | 1730479155 |
---|---|
Name: | STEPHEN J CHIARELLO LTD |
Entity Type: | Organization |
Organization Name: | STEPHEN J CHIARELLO LTD |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DOCTOR |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | STEPHEN |
Authorized Official - Middle Name: | J |
Authorized Official - Last Name: | CHIARELLO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DC |
Authorized Official - Phone: | 702-362-6303 |
Mailing Address - Street 1: | 2815 S JONES BLVD |
Mailing Address - Street 2: | |
Mailing Address - City: | LAS VEGAS |
Mailing Address - State: | NV |
Mailing Address - Zip Code: | 89146-5307 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 702-362-6303 |
Mailing Address - Fax: | 702-362-6607 |
Practice Address - Street 1: | 2815 S JONES BLVD |
Practice Address - Street 2: | |
Practice Address - City: | LAS VEGAS |
Practice Address - State: | NV |
Practice Address - Zip Code: | 89146-5307 |
Practice Address - Country: | US |
Practice Address - Phone: | 702-362-6303 |
Practice Address - Fax: | 702-362-6607 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2011-04-19 |
Last Update Date: | 2011-12-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NV | 1000050-205 | 111N00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 111N00000X | Chiropractic Providers | Chiropractor | Group - Single Specialty |