Provider Demographics
NPI:1619984549
Name:FAGAN, CHRISTINE M (DC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:FAGAN
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 1:11 FRIENDS LN
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1803
Mailing Address - Country:US
Mailing Address - Phone:215-860-3256
Mailing Address - Fax:
Practice Address - Street 1:11 FRIENDS LN
Practice Address - Street 2:STE 110
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-1803
Practice Address - Country:US
Practice Address - Phone:215-860-3256
Practice Address - Fax:215-579-1453
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC005051L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U61051Medicare UPIN
PA608662Medicare ID - Type Unspecified