Provider Demographics
NPI:1023112422
Name:FAZZINO, WILLIAM ALBERT (DC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ALBERT
Last Name:FAZZINO
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 1:76 PINOAK DR
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:RI
Mailing Address - Zip Code:02822
Mailing Address - Country:US
Mailing Address - Phone:401-294-0113
Mailing Address - Fax:
Practice Address - Street 1:202 WORCESTER ST
Practice Address - Street 2:SUITE 10
Practice Address - City:NORTH GRAFTON
Practice Address - State:MA
Practice Address - Zip Code:01536
Practice Address - Country:US
Practice Address - Phone:508-839-9100
Practice Address - Fax:508-839-9100
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1767111N00000X
RI0329111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U43526Medicare UPIN
007057430Medicare ID - Type Unspecified