Provider Demographics
NPI:1669570677
Name:FAY, RICHARD R (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:R
Last Name:FAY
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 1:2S567 WHITE BIRCH LN
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-1614
Mailing Address - Country:US
Mailing Address - Phone:630-961-0259
Mailing Address - Fax:630-961-2406
Practice Address - Street 1:1795 S WASHINGTON ST STE 109
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-2058
Practice Address - Country:US
Practice Address - Phone:331-401-5900
Practice Address - Fax:331-215-7318
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-004257111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02232874OtherBLUE CROSS/BLUE SHIELD
IL667681Medicare ID - Type Unspecified