MEDICARE: DR. JEN FABER 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	0104556548	VA
2	111N00000X	Chiropractor	CH030076	DC
3	111N00000X	Chiropractor	4270-12	WI
4	111N00000X	Chiropractor	CHR-6008	CO

General Provider Information

NPI Number	:	1699969626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEN FABER D.C.

Provider Business Mailing Address
First Line	:	33388 VALLEY LN
Second Line	:
City	:	LONE ROCK
State	:	WI
Zip	:	53556-4149
Country	:	US
Telephone Number	:	703-300-0145
Fax Number	:

Provider Business Practice Location Address
First Line	:	33388 VALLEY LN
Second Line	:
City	:	LONE ROCK
State	:	WI
Zip	:	53556-4149
Country	:	US
Telephone Number	:	703-300-0145
Fax Number	:

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

Provider Enumeration Date	:	09/03/2007
Last Update Date	:	05/14/2010

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