Provider Demographics
NPI:1942597810
Name:FAZEY, STEPHEN MARK (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MARK
Last Name:FAZEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4220 W WILLIAM CANNON DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-1569
Mailing Address - Country:US
Mailing Address - Phone:512-892-3434
Mailing Address - Fax:512-892-3433
Practice Address - Street 1:4220 W WILLIAM CANNON DR
Practice Address - Street 2:SUITE 130
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-1569
Practice Address - Country:US
Practice Address - Phone:512-892-3434
Practice Address - Fax:512-892-3433
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8893111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor