MEDICARE: DR. WILLIAM KEVIN FALLIS DC

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		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2660	OTHER	MO	BLUE CROSS BLUE SHIELD
2	6082088	OTHER	IL	BULE CROSS BLUE SHEILD
3	4407353	OTHER	IL	UNITED HEALTH CARE

General Provider Information

NPI Number	:	1255332342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM KEVIN FALLIS DC

Provider Business Mailing Address
First Line	:	115 S MAIN ST
Second Line	:
City	:	TROY
State	:	IL
Zip	:	62294-1425
Country	:	US
Telephone Number	:	618-667-7003
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 S MAIN ST
Second Line	:
City	:	TROY
State	:	IL
Zip	:	62294-1425
Country	:	US
Telephone Number	:	618-667-7003
Fax Number	:

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	07/08/2007

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