Provider Demographics
NPI:1912984204
Name:FANNING, PATRICIA ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:ANN
Last Name:FANNING
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:932 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHESTERTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21620-3324
Mailing Address - Country:US
Mailing Address - Phone:410-810-0530
Mailing Address - Fax:410-810-0200
Practice Address - Street 1:932 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620-3324
Practice Address - Country:US
Practice Address - Phone:410-870-0530
Practice Address - Fax:410-810-0200
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV623111N00000X
PADC 005770L111N00000X
DEF1-0000778111N00000X
MDS01718111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD366QMedicare PIN