MEDICARE: DR. ROBERT J FAST DC

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	111N00000X	Chiropractor	038009109	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00110676	OTHER	IL	MEDICARE RR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	627824	OTHER	IL	ULTC
2	900068033	OTHER	IL	ESSENCE

General Provider Information

NPI Number	:	1275539611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT J FAST DC

Provider Business Mailing Address
First Line	:	5206 W MAIN ST
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62226-4731
Country	:	US
Telephone Number	:	628-234-5200
Fax Number	:	618-234-4400

Provider Business Practice Location Address
First Line	:	5206 W MAIN ST
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62226-4731
Country	:	US
Telephone Number	:	628-234-5200
Fax Number	:	618-234-4400

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

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	07/31/2017

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Directions to “ DR. ROBERT J FAST DC” Practice Location

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