Provider Demographics
NPI:1780947945
Name:FASKEN CHIROPRACTIC AND WELLNESS LLC
Entity type:Organization
Organization Name:FASKEN CHIROPRACTIC AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAYNA
Authorized Official - Middle Name:LOREN
Authorized Official - Last Name:FASKEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:573-442-8959
Mailing Address - Street 1:2501 W ASH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-4609
Mailing Address - Country:US
Mailing Address - Phone:573-442-8959
Mailing Address - Fax:573-443-8959
Practice Address - Street 1:2501 W ASH ST
Practice Address - Street 2:SUITE B
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-4609
Practice Address - Country:US
Practice Address - Phone:573-442-8959
Practice Address - Fax:573-443-8959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-21
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty