Provider Demographics
NPI:1730166752
Name:CHIARELLO, STEPHEN J
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:CHIARELLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:89146-5628
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:89146-5628
Practice Address - Country:US
Practice Address - Phone:702-362-6303
Practice Address - Fax:702-362-6607
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-30
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB00337111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV5624620001Medicare NSC
T67166Medicare UPIN