Provider Demographics
NPI:1609870294
Name:FACCIN, CHRISTINA (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:
Last Name:FACCIN
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 1:4105 HUMBERT RD STE 102
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-7161
Mailing Address - Country:US
Mailing Address - Phone:618-463-1600
Mailing Address - Fax:618-463-1624
Practice Address - Street 1:4105 HUMBERT RD STE 102
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-7161
Practice Address - Country:US
Practice Address - Phone:618-463-1600
Practice Address - Fax:618-463-1624
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009622111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL119180OtherGHP
IL664851OtherUNITED HEALTH CARE
ILP00058381OtherRAILROAD MEDICARE
IL06032043OtherBLUE CROSS BLUE SHIELD
IL478038OtherHEALTHLINK
ILU91683OtherMERCY HEALTH PLANS
U91683Medicare UPIN
IL664851OtherUNITED HEALTH CARE