Provider Demographics
NPI:1396190872
Name:FANARO, ZACHARY (DC, LAC)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:FANARO
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LURAY
Mailing Address - State:VA
Mailing Address - Zip Code:22835-2031
Mailing Address - Country:US
Mailing Address - Phone:540-713-2322
Mailing Address - Fax:
Practice Address - Street 1:303 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LURAY
Practice Address - State:VA
Practice Address - Zip Code:22835-2031
Practice Address - Country:US
Practice Address - Phone:540-713-2322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-03
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557315111N00000X
VA0121000817171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist