Healthcare Provider Details

I. General information

NPI: 1265408686
Provider Name (Legal Business Name): WILLIAM SCOTT FAGER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

552 E NORTHWEST HWY
PALATINE IL
60074-6355
US

IV. Provider business mailing address

552 E NORTHWEST HWY
PALATINE IL
60074-6355
US

V. Phone/Fax

Practice location:
  • Phone: 847-991-2222
  • Fax: 847-991-8815
Mailing address:
  • Phone: 847-991-2222
  • Fax: 847-991-8815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: