Provider Demographics
NPI:1669701264
Name:FANNING, BRIAN D JR (MS, ACI, ATC)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:D
Last Name:FANNING
Suffix:JR
Gender:M
Credentials:MS, ACI, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 WOOD DUCK CT
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-3312
Mailing Address - Country:US
Mailing Address - Phone:973-229-6280
Mailing Address - Fax:973-353-1431
Practice Address - Street 1:22 WOOD DUCK CT
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-3312
Practice Address - Country:US
Practice Address - Phone:973-229-6280
Practice Address - Fax:973-353-1431
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-11
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT001228002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer