MEDICARE: DR. KODY FAGIN 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	2301401380	MI

General Provider Information

NPI Number	:	1447939020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KODY FAGIN DC

Provider Business Mailing Address
First Line	:	2614 S ADAMS RD
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-5509
Country	:	US
Telephone Number	:	248-897-0699
Fax Number	:

Provider Business Practice Location Address
First Line	:	2614 S ADAMS RD
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-5509
Country	:	US
Telephone Number	:	248-897-0699
Fax Number	:

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

Provider Enumeration Date	:	07/12/2023
Last Update Date	:	07/12/2023

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Directions to “ DR. KODY FAGIN DC” Practice Location

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