Provider Demographics
NPI:1790018836
Name:FAZIO, DANIEL MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:MICHAEL
Last Name:FAZIO
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 1:456 N. NEW BALLAS RD.
Mailing Address - Street 2:SUITE 342
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141
Mailing Address - Country:US
Mailing Address - Phone:314-528-8395
Mailing Address - Fax:314-474-0212
Practice Address - Street 1:456 N. NEW BALLAS RD.
Practice Address - Street 2:SUITE 342
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-528-8395
Practice Address - Fax:314-474-0212
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009030088111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor