Provider Demographics
NPI:1780644435
Name:BAHOORA, KENNETH M (DC)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:M
Last Name:BAHOORA
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 1:321 N PECOS RD STE 200
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-1348
Mailing Address - Country:US
Mailing Address - Phone:702-263-4925
Mailing Address - Fax:702-263-6874
Practice Address - Street 1:321 N PECOS RD
Practice Address - Street 2:200
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-1347
Practice Address - Country:US
Practice Address - Phone:702-263-4925
Practice Address - Fax:702-263-6874
Is Sole Proprietor?:No
Enumeration Date:2006-03-26
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB00760111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVU83572Medicare UPIN
NV102261Medicare PIN