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General NPI Number Information
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NPI Number | 1104131218
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Entity Type | Organization
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Legal Business Name | FUSION HEALTH AND FITNESS
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Dates
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Enumeration Date | 08/12/2010
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Last Update Date | 05/03/2011
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Provider Practice Location Address
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Address Line | 7 SHERWOOD CT
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City | LAKE IN THE HILLS
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State | IL
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Zip | 60156-5929
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Country | US
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Telephone | 815-404-3727
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Fax |
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Provider Business Mailing Address
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Address Line | 7 SHERWOOD CT
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City | LAKE IN THE HILLS
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State | IL
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Zip | 60156-5929
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Country | US
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Telephone | 815-404-3727
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | ANDREW CARR JR.
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Credential | D.C.
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Telephone | 815-404-3727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038008417
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License Number State | IL
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