MEDICARE: DR. RUSS F. FASOLINO 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	2475	CO

General Provider Information

NPI Number	:	1174528749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUSS F. FASOLINO D.C.

Provider Business Mailing Address
First Line	:	PO BOX 772583
Second Line	:	320 OAK STREET
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80477-2583
Country	:	US
Telephone Number	:	970-870-8888
Fax Number	:	970-870-3076

Provider Business Practice Location Address
First Line	:	320 OAK STREET
Second Line	:
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80477
Country	:	US
Telephone Number	:	970-870-8888
Fax Number	:	970-870-3076

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

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	11/09/2007

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