Provider Demographics
NPI:1376811943
Name:ROBERT FADY, D.C., P.A.
Entity Type:Organization
Organization Name:ROBERT FADY, D.C., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:FADY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-585-4300
Mailing Address - Street 1:490 INDIAN ROCKS RD N
Mailing Address - Street 2:SUITE B
Mailing Address - City:BELLEAIR BLUFFS
Mailing Address - State:FL
Mailing Address - Zip Code:33770-2085
Mailing Address - Country:US
Mailing Address - Phone:727-585-4300
Mailing Address - Fax:727-585-5335
Practice Address - Street 1:490 INDIAN ROCKS RD N
Practice Address - Street 2:SUITE B
Practice Address - City:BELLEAIR BLUFFS
Practice Address - State:FL
Practice Address - Zip Code:33770-2085
Practice Address - Country:US
Practice Address - Phone:727-585-4300
Practice Address - Fax:727-585-5335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH3986111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty