Provider Demographics
NPI:1457532244
Name:STEPHEN L. FAIR, D.C., LTD
Entity Type:Organization
Organization Name:STEPHEN L. FAIR, D.C., LTD
Other - Org Name:AMERICAN SPINE & SPORTS REHBILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARRIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MINADEO KNUTSON
Authorized Official - Suffix:
Authorized Official - Credentials:CMA-A
Authorized Official - Phone:702-256-8080
Mailing Address - Street 1:500 N RAINBOW BLVD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-1082
Mailing Address - Country:US
Mailing Address - Phone:702-256-8080
Mailing Address - Fax:702-256-8081
Practice Address - Street 1:500 N RAINBOW BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-1082
Practice Address - Country:US
Practice Address - Phone:702-256-8080
Practice Address - Fax:702-256-8081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB00922111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV04508Medicare UPIN
NVV100508Medicare PIN