Provider Demographics
NPI:1215067129
Name:FABIANO, CASSANDRA (DC)
Entity type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:
Last Name:FABIANO
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 1:2590 CHERRY DR
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-4531
Mailing Address - Country:US
Mailing Address - Phone:435-734-1290
Mailing Address - Fax:
Practice Address - Street 1:505 E 200 S
Practice Address - Street 2:SUITE 425
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-2022
Practice Address - Country:US
Practice Address - Phone:801-363-0060
Practice Address - Fax:801-363-3926
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT61241861202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor