Provider Demographics
NPI:1598899189
Name:FABIANO, RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:FABIANO
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 1:211 GILMORE AVE
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16127-1614
Mailing Address - Country:US
Mailing Address - Phone:724-458-5186
Mailing Address - Fax:
Practice Address - Street 1:211 GILMORE AVE
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:PA
Practice Address - Zip Code:16127-1614
Practice Address - Country:US
Practice Address - Phone:724-458-5186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC 004010-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAFA610352OtherBLUE SHIELD