Provider Demographics
NPI:1447524855
Name:KEVIN THOMAS BAHOORA ADVANCED SPINE AND WELLNESS
Entity type:Organization
Organization Name:KEVIN THOMAS BAHOORA ADVANCED SPINE AND WELLNESS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN/OWNER/PRES
Authorized Official - Prefix:
Authorized Official - First Name:KEVEN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BAHOORA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:702-396-0277
Mailing Address - Street 1:7035 W. ANN RD #160
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-3868
Mailing Address - Country:US
Mailing Address - Phone:702-396-0277
Mailing Address - Fax:702-396-3790
Practice Address - Street 1:7035 W. ANN RD #160
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-3868
Practice Address - Country:US
Practice Address - Phone:702-396-0277
Practice Address - Fax:702-396-3790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-02
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB-799111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty