Provider Demographics
NPI:1194915850
Name:FABRIZIO, THERESA A (DC)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:A
Last Name:FABRIZIO
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 1:1790 N MAIN RD
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-2559
Mailing Address - Country:US
Mailing Address - Phone:856-692-0077
Mailing Address - Fax:
Practice Address - Street 1:1790 N MAIN RD
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-2559
Practice Address - Country:US
Practice Address - Phone:856-692-0077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00657700111N00000X
NY0113551111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor