MEDICARE: FITFIX WELLNESS LLC

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
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1669802369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FITFIX WELLNESS LLC

Provider Business Mailing Address
First Line	:	1224 E KATELLA AVE STE 216
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92867-5049
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1224 E KATELLA AVE STE 216
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92867-5049
Country	:	US
Telephone Number	:	949-872-7728
Fax Number	:

Authorized Official
Title or Position	:	BILLER
Name	:	JOE CROUCH
Credential	:
Telephone Number	:	626-358-0093

Provider Enumeration Date	:	11/15/2013
Last Update Date	:	11/15/2013

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Directions to “FITFIX WELLNESS LLC ” Practice Location

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