=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669570677
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICHARD R. FAY DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2006
-----------------------------------------------------
Last Update Date | 10/14/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1795 S WASHINGTON ST STE 109
-----------------------------------------------------
City | NAPERVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60565-2058
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 331-401-5900
-----------------------------------------------------
Fax | 331-215-7318
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2S567 WHITE BIRCH LN
-----------------------------------------------------
City | WHEATON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60187-1614
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-961-0259
-----------------------------------------------------
Fax | 630-961-2406
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 038-004257
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------