Provider Demographics
NPI:1386792737
Name:FAUBION, JONATHAN L (DC)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:L
Last Name:FAUBION
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:PO BOX 1457
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-0160
Mailing Address - Country:US
Mailing Address - Phone:307-856-6612
Mailing Address - Fax:307-856-1767
Practice Address - Street 1:621 N 10TH ST E
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-2906
Practice Address - Country:US
Practice Address - Phone:307-856-6612
Practice Address - Fax:307-856-1767
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY645111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW21380Medicare PIN