Provider Demographics
NPI:1043368434
Name:FACCIN CHIROPRACTIC, PC
Entity type:Organization
Organization Name:FACCIN CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:FACCIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-258-8610
Mailing Address - Street 1:2 TERMINAL DR
Mailing Address - Street 2:SUITE 8B
Mailing Address - City:EAST ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62024-2268
Mailing Address - Country:US
Mailing Address - Phone:618-258-8610
Mailing Address - Fax:
Practice Address - Street 1:2 TERMINAL DR
Practice Address - Street 2:SUITE 8B
Practice Address - City:EAST ALTON
Practice Address - State:IL
Practice Address - Zip Code:62024-2268
Practice Address - Country:US
Practice Address - Phone:618-258-8610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherTAX ID