Provider Demographics
NPI:1659324861
Name:FASICK, DOUGLAS A (D C)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:A
Last Name:FASICK
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19363-1403
Mailing Address - Country:US
Mailing Address - Phone:610-932-9061
Mailing Address - Fax:302-655-8398
Practice Address - Street 1:25 N 3RD ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:PA
Practice Address - Zip Code:19363-1423
Practice Address - Country:US
Practice Address - Phone:610-932-9061
Practice Address - Fax:302-655-8398
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004353L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor