Provider Demographics
NPI:1790829984
Name:FABOZZI, JEFFREY D (DC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:D
Last Name:FABOZZI
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 1:600 N STATE OF FRANKLIN RD
Mailing Address - Street 2:STE. 15
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-8226
Mailing Address - Country:US
Mailing Address - Phone:423-929-2773
Mailing Address - Fax:423-929-7474
Practice Address - Street 1:600 N STATE OF FRANKLIN RD
Practice Address - Street 2:STE. 15
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-8226
Practice Address - Country:US
Practice Address - Phone:423-929-2773
Practice Address - Fax:423-929-7474
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC1236111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNU58294Medicare UPIN
TN3678015Medicare ID - Type Unspecified