MEDICARE: DR. JOEL KEITH FISH 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	111N00000X	Chiropractor	038-006511	IL

General Provider Information

NPI Number	:	1285748939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOEL KEITH FISH D.C.

Provider Business Mailing Address
First Line	:	34930 N US HIGHWAY 45
Second Line	:	SUITE 109
City	:	LAKE VILLA
State	:	IL
Zip	:	60046-7537
Country	:	US
Telephone Number	:	847-662-1920
Fax Number	:

Provider Business Practice Location Address
First Line	:	34930 N US HIGHWAY 45
Second Line	:	SUITE 109
City	:	LAKE VILLA
State	:	IL
Zip	:	60046-7537
Country	:	US
Telephone Number	:	847-662-1920
Fax Number	:

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

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	08/18/2014

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