Provider Demographics
NPI:1720144249
Name:VEGAS VALLEY REHABILITATION LLC
Entity Type:Organization
Organization Name:VEGAS VALLEY REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:FAIR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:702-256-8080
Mailing Address - Street 1:500 N RAINBOW BLVD
Mailing Address - Street 2:STE 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:STE 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:2006-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty