Provider Demographics
NPI:1316159080
Name:FAUBION CHIROPRACTIC PC
Entity type:Organization
Organization Name:FAUBION CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:E
Authorized Official - Last Name:FAUBION
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:307-685-2225
Mailing Address - Street 1:405 W BOXELDER RD
Mailing Address - Street 2:SUITE A1
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-5320
Mailing Address - Country:US
Mailing Address - Phone:307-685-2225
Mailing Address - Fax:307-685-6436
Practice Address - Street 1:405 W BOXELDER RD
Practice Address - Street 2:SUITE A1
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-5320
Practice Address - Country:US
Practice Address - Phone:307-685-2225
Practice Address - Fax:307-685-6436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY602111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY311379OtherBLUE CROSS BLUE SHIELD
WY20697Medicare ID - Type Unspecified
U89423Medicare UPIN