MEDICARE: DR. ROBERT WALTER FETTIG 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	DC19113	CA

General Provider Information

NPI Number	:	1114904547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT WALTER FETTIG D.C

Provider Business Mailing Address
First Line	:	4524 BABICH AVE
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95822-1907
Country	:	US
Telephone Number	:	916-736-1001
Fax Number	:	916-736-9001

Provider Business Practice Location Address
First Line	:	1221 ALHAMBRA BLVD
Second Line	:	105
City	:	SACRAMENTO
State	:	CA
Zip	:	95816-5237
Country	:	US
Telephone Number	:	916-451-5552
Fax Number	:	916-451-0756

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

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	07/08/2007

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