MEDICARE: DR. RON R. FAROTTO 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	5478	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10228X	OTHER	MO	BC/BS ID
2	203BG0000X	OTHER	MO	HEALTHLINK CODE
3	44-80052	OTHER	MO	UNITED HEALTH CARE PROVID
4	5938070	OTHER	MO	AETNA PIN CODE
5	4348100	OTHER	MO	CIGNA ID

General Provider Information

NPI Number	:	1447264627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RON R. FAROTTO D.C.

Provider Business Mailing Address
First Line	:	5820 S GRAND BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63111-2305
Country	:	US
Telephone Number	:	314-351-4273
Fax Number	:	800-595-7476

Provider Business Practice Location Address
First Line	:	5820 S GRAND BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63111-2305
Country	:	US
Telephone Number	:	314-351-4273
Fax Number	:	800-595-7476

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	06/03/2010

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Directions to “ DR. RON R. FAROTTO D.C.” Practice Location

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