Healthcare Provider Details

I. General information

NPI: 1609827252
Provider Name (Legal Business Name): JOHN W FABIANEK D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 03/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 BAY PL
ANACORTES WA
98221-2923
US

IV. Provider business mailing address

1907 BAY PL
ANACORTES WA
98221-2923
US

V. Phone/Fax

Practice location:
  • Phone: 360-317-5229
  • Fax: 360-378-3015
Mailing address:
  • Phone: 360-317-5229
  • Fax: 360-378-3015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00000727
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: