Phil Fortier, D.C.
Individual provider Active NPI Chiropractor · Roanoke, TX
NPI 1154414647 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1154414647
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 6429 (TX)
- Practice address
- 509 E. Byron Nelson Blvd.
A
Roanoke, TX 76262 - Phone
- (817) 430-8459
- Fax
- (817) 491-7188
- NPI assigned
- Oct 2, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 6429 | TX | Yes |
Addresses
Primary practice location
509 E. Byron Nelson Blvd.
A
Roanoke, TX 76262
Mailing address
509 E. Byron Nelson Blvd.
A
Roanoke, TX 76262
Phone (817) 430-8459
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 605797 | Other | TX | BLUE CROSS BLUE SHIELD |
| 5953432 | Other | TX | AETNA |
| 1797201 | Medicaid | TX |
Other providers in Roanoke, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.