Provider Demographics
NPI:1720492663
Name:LAM, KIET MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:KIET
Middle Name:MICHAEL
Last Name:LAM
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 1:5693 S. JONES BVLD
Mailing Address - Street 2:STE 116
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-2530
Mailing Address - Country:US
Mailing Address - Phone:702-735-0212
Mailing Address - Fax:702-735-0214
Practice Address - Street 1:5693 S. JONES BVLD
Practice Address - Street 2:STE 116
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118
Practice Address - Country:US
Practice Address - Phone:702-735-0212
Practice Address - Fax:702-735-0214
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-18
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01053111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor