Healthcare Provider Details

I. General information

NPI: 1023112422
Provider Name (Legal Business Name): WILLIAM ALBERT FAZZINO DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 09/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 WORCESTER ST SUITE 10
NORTH GRAFTON MA
01536
US

IV. Provider business mailing address

76 PINOAK DR
EXETER RI
02822
US

V. Phone/Fax

Practice location:
  • Phone: 508-839-9100
  • Fax: 508-839-9100
Mailing address:
  • Phone: 401-294-0113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1767
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0329
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: