Provider Demographics
NPI:1063615532
Name:FACCONE, AUSTIN GERARD (DC)
Entity type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:GERARD
Last Name:FACCONE
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 1:201 WEST ARROWOOD ROAD
Mailing Address - Street 2:SUITE EE
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217
Mailing Address - Country:US
Mailing Address - Phone:704-565-4999
Mailing Address - Fax:704-334-7059
Practice Address - Street 1:201 WEST ARROWOOD ROAD
Practice Address - Street 2:SUITE EE
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217
Practice Address - Country:US
Practice Address - Phone:704-565-4999
Practice Address - Fax:704-334-7059
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2707111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor