MEDICARE: DR. THOMAS J FASTIGGI 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	001272	CT

General Provider Information

NPI Number	:	1316004591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS J FASTIGGI D.C.

Provider Business Mailing Address
First Line	:	838 HIGH RIDGE RD
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06905-1913
Country	:	US
Telephone Number	:	203-329-2800
Fax Number	:	203-968-9692

Provider Business Practice Location Address
First Line	:	838 HIGH RIDGE RD
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06905-1913
Country	:	US
Telephone Number	:	203-329-2800
Fax Number	:	203-968-9692

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

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	07/09/2007

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