Provider Demographics
NPI:1760778211
Name:FABACHER, PATRICK S (DC)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:S
Last Name:FABACHER
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 1:4352 BREMNER DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-3615
Mailing Address - Country:US
Mailing Address - Phone:512-784-0837
Mailing Address - Fax:512-326-5335
Practice Address - Street 1:1007 S CONGRESS AVE STE B11
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-8723
Practice Address - Country:US
Practice Address - Phone:512-326-5333
Practice Address - Fax:512-326-5335
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6668111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU61004Medicare UPIN