Provider Demographics
NPI:1609827252
Name:FABIANEK, JOHN W (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:FABIANEK
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 1:1907 BAY PL
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-2923
Mailing Address - Country:US
Mailing Address - Phone:360-317-5229
Mailing Address - Fax:360-378-3015
Practice Address - Street 1:1907 BAY PL
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-2923
Practice Address - Country:US
Practice Address - Phone:360-317-5229
Practice Address - Fax:360-378-3015
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00000727111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAT60962Medicare UPIN
WAAB39875Medicare ID - Type Unspecified