Provider Demographics
NPI:1720676026
Name:FAUST, BLAIR DANIEL (DC)
Entity Type:Individual
Prefix:
First Name:BLAIR
Middle Name:DANIEL
Last Name:FAUST
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 1:1355 FOUR MILE DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-1932
Mailing Address - Country:US
Mailing Address - Phone:570-322-1776
Mailing Address - Fax:570-322-1774
Practice Address - Street 1:1355 FOUR MILE DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-1932
Practice Address - Country:US
Practice Address - Phone:570-322-1776
Practice Address - Fax:570-322-1774
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor