Provider Demographics
NPI:1275001711
Name:FANTASIA, STEVEN B (DC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:B
Last Name:FANTASIA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15445 COBALT ST SPC 204
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-0532
Mailing Address - Country:US
Mailing Address - Phone:818-939-7224
Mailing Address - Fax:
Practice Address - Street 1:15445 COBALT ST SPC 204
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-0532
Practice Address - Country:US
Practice Address - Phone:818-939-7224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34241111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor