MEDICARE: DR. DOMINIQUE KATHERINE PITACCIO D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NR0400X	Rehabilitation Chiropractor	B01346	NV

General Provider Information

NPI Number	:	1164786109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOMINIQUE KATHERINE PITACCIO D.C.

Provider Business Mailing Address
First Line	:	7035 W ANN RD
Second Line	:	SUITE 160
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-3863
Country	:	US
Telephone Number	:	702-396-0277
Fax Number	:	702-396-3790

Provider Business Practice Location Address
First Line	:	7035 W ANN RD
Second Line	:	SUITE 160
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-3863
Country	:	US
Telephone Number	:	702-396-0277
Fax Number	:	702-396-3790

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2012
Last Update Date	:	06/25/2012

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