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NPI Code Detail

MEDICARE: DR. ROB FAST LLC

MEDICARE: DR. ROB FAST 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
1111N00000XChiropractor038009109IL

General Provider Information

NPI Number : 1700293644
Entity Type Code : Organization
Provider Name (Legal Business Name) : DR. ROB FAST LLC
Provider Business Mailing Address
First Line : 5206 W MAIN ST
Second Line :
City : BELLEVILLE
State : IL
Zip : 62226-4731
Country : US
Telephone Number : 618-234-5200
Fax Number : 618-234-4400
Provider Business Practice Location Address
First Line : 5206 W MAIN ST
Second Line :
City : BELLEVILLE
State : IL
Zip : 62226-4731
Country : US
Telephone Number : 618-234-5200
Fax Number : 618-234-4400
Authorized Official
Title or Position : OWNER
Name : DR. ROBERT J FAST
Credential : DC
Telephone Number : 314-704-4150
Provider Enumeration Date : 07/11/2014
Last Update Date : 07/24/2014

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Directions to “DR. ROB FAST LLC ” Practice Location

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