Provider Demographics
NPI:1417237132
Name:FASSL, JOANNA R (DC)
Entity Type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:R
Last Name:FASSL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 PINE ST STE 505
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-3225
Mailing Address - Country:US
Mailing Address - Phone:415-434-1530
Mailing Address - Fax:415-434-1533
Practice Address - Street 1:332 PINE ST STE 505
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-3225
Practice Address - Country:US
Practice Address - Phone:415-434-1530
Practice Address - Fax:415-434-1533
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31991111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor