MEDICARE: KEVIN FLUITT 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	11700	TX

General Provider Information

NPI Number	:	1871880252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN FLUITT D.C.

Provider Business Mailing Address
First Line	:	3005 S LAMAR BLVD STE D-112
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-8864
Country	:	US
Telephone Number	:	512-441-1240
Fax Number	:	512-441-3762

Provider Business Practice Location Address
First Line	:	3005 S LAMAR BLVD STE D-112
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-8864
Country	:	US
Telephone Number	:	512-441-1240
Fax Number	:	512-441-3762

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

Provider Enumeration Date	:	07/06/2011
Last Update Date	:	07/06/2011

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