MEDICARE: DR. SARAH A FULCO 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	B01673	NV

General Provider Information

NPI Number	:	1447765128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARAH A FULCO DC

Provider Business Mailing Address
First Line	:	4567 W FLAMINGO RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-3702
Country	:	US
Telephone Number	:	702-368-3463
Fax Number	:	702-368-0027

Provider Business Practice Location Address
First Line	:	4567 W FLAMINGO RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-3702
Country	:	US
Telephone Number	:	702-368-3463
Fax Number	:	702-368-0027

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

Provider Enumeration Date	:	12/04/2017
Last Update Date	:	12/04/2017

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