MEDICARE: DR. CHASE STEPHEN FIFAREK 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	CH10825	FL

General Provider Information

NPI Number	:	1124369178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHASE STEPHEN FIFAREK D.C.

Provider Business Mailing Address
First Line	:	1104 L PAVIA BLVD
Second Line	:
City	:	VENICE
State	:	FL
Zip	:	34292-5327
Country	:	US
Telephone Number	:	517-281-4482
Fax Number	:

Provider Business Practice Location Address
First Line	:	12479 S ACCESS RD STE 1
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33981-6206
Country	:	US
Telephone Number	:	941-697-3001
Fax Number	:

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

Provider Enumeration Date	:	03/14/2013
Last Update Date	:	03/14/2013

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