Provider Demographics
NPI:1790936292
Name:FANCHER, CAROLYN J (DC)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:J
Last Name:FANCHER
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 1:2140 CALIFORNIA AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-2164
Mailing Address - Country:US
Mailing Address - Phone:206-659-0771
Mailing Address - Fax:206-659-0784
Practice Address - Street 1:2140 CALIFORNIA AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-2164
Practice Address - Country:US
Practice Address - Phone:206-659-0771
Practice Address - Fax:206-659-0784
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034883111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor