Provider Demographics
NPI:1346206885
Name:DEFAZIO, CLAIRE L (DC)
Entity type:Individual
Prefix:DR
First Name:CLAIRE
Middle Name:L
Last Name:DEFAZIO
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 1:2738 FISCHER RD
Mailing Address - Street 2:
Mailing Address - City:HATFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19440-2899
Mailing Address - Country:US
Mailing Address - Phone:215-412-2090
Mailing Address - Fax:215-412-2090
Practice Address - Street 1:2738 FISCHER RD
Practice Address - Street 2:
Practice Address - City:HATFIELD
Practice Address - State:PA
Practice Address - Zip Code:19440-2899
Practice Address - Country:US
Practice Address - Phone:215-412-2090
Practice Address - Fax:215-412-2090
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005799L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU69005Medicare UPIN