MEDICARE: DR. JACOB WAYNE FISK 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	B01260	NV
2	111NI0013X	Independent Medical Examiner Chiropractor	B01260	NV

General Provider Information

NPI Number	:	1922208321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACOB WAYNE FISK D.C.

Provider Business Mailing Address
First Line	:	241 N BUFFALO DR STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-0307
Country	:	US
Telephone Number	:	702-852-1390
Fax Number	:	702-577-3334

Provider Business Practice Location Address
First Line	:	241 N BUFFALO DR STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-0307
Country	:	US
Telephone Number	:	702-852-1390
Fax Number	:	702-577-3334

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

Provider Enumeration Date	:	07/23/2007
Last Update Date	:	05/27/2021

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