MEDICARE: DR. JUSTIN ANTHONY FORTIER 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	111NS0005X	Sports Physician Chiropractor	11395	TX

General Provider Information

NPI Number	:	1376860270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTIN ANTHONY FORTIER D.C.

Provider Business Mailing Address
First Line	:	7001 W PARKER RD
Second Line	:	APARTMENT 534
City	:	PLANO
State	:	TX
Zip	:	75093-8614
Country	:	US
Telephone Number	:	972-742-7912
Fax Number	:

Provider Business Practice Location Address
First Line	:	6350 LBJ FWY
Second Line	:	SUITE 166
City	:	DALLAS
State	:	TX
Zip	:	75240-6403
Country	:	US
Telephone Number	:	972-742-7912
Fax Number	:

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

Provider Enumeration Date	:	05/01/2010
Last Update Date	:	05/01/2010

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