MEDICARE: DR. JOHN FITZGERALD 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	B01047	NV
2	111NN1001X	Nutrition Chiropractor	B01047	NV

General Provider Information

NPI Number	:	1568603447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN FITZGERALD D.C.

Provider Business Mailing Address
First Line	:	7355 BERMUDA ISLAND ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-1172
Country	:	US
Telephone Number	:	702-372-5195
Fax Number	:

Provider Business Practice Location Address
First Line	:	7355 BERMUDA ISLAND ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-1172
Country	:	US
Telephone Number	:	702-372-5195
Fax Number	:

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

Provider Enumeration Date	:	03/23/2009
Last Update Date	:	03/23/2009

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