MEDICARE: DR. RICHARD FABIANO DC

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	DC 004010-L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	FA610352	OTHER	PA	BLUE SHIELD

General Provider Information

NPI Number	:	1598899189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD FABIANO DC

Provider Business Mailing Address
First Line	:	211 GILMORE AVE
Second Line	:
City	:	GROVE CITY
State	:	PA
Zip	:	16127-1614
Country	:	US
Telephone Number	:	724-458-5186
Fax Number	:

Provider Business Practice Location Address
First Line	:	211 GILMORE AVE
Second Line	:
City	:	GROVE CITY
State	:	PA
Zip	:	16127-1614
Country	:	US
Telephone Number	:	724-458-5186
Fax Number	:

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

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	07/08/2007

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