MEDICARE: FITNATION CHIROPRACTIC

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

General Provider Information

NPI Number	:	1861862088
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FITNATION CHIROPRACTIC

Provider Business Mailing Address
First Line	:	3191 SPORTS ARENA BLVD STE B
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-4569
Country	:	US
Telephone Number	:	858-509-7999
Fax Number	:

Provider Business Practice Location Address
First Line	:	3191 SPORTS ARENA BLVD STE B
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-4569
Country	:	US
Telephone Number	:	858-509-7999
Fax Number	:

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	PAM NOYES
Credential	:
Telephone Number	:	858-509-7999

Provider Enumeration Date	:	09/30/2015
Last Update Date	:	09/30/2015

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Directions to “FITNATION CHIROPRACTIC ” Practice Location

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