Provider Demographics
NPI:1386922862
Name:FAZZIO, LEON JOSEPH III (DC)
Entity type:Individual
Prefix:DR
First Name:LEON
Middle Name:JOSEPH
Last Name:FAZZIO
Suffix:III
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 1:29 COLLEGE RD STE 8B1
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-1739
Mailing Address - Country:US
Mailing Address - Phone:907-456-3302
Mailing Address - Fax:
Practice Address - Street 1:29 COLLEGE RD STE 8B1
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-1739
Practice Address - Country:US
Practice Address - Phone:907-456-3302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-01
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6670111N00000X
AK596111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor