Provider Demographics
NPI:1699969626
Name:FABER, JEN (DC)
Entity type:Individual
Prefix:DR
First Name:JEN
Middle Name:
Last Name:FABER
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 1:33388 VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:LONE ROCK
Mailing Address - State:WI
Mailing Address - Zip Code:53556-4149
Mailing Address - Country:US
Mailing Address - Phone:703-300-0145
Mailing Address - Fax:
Practice Address - Street 1:33388 VALLEY LN
Practice Address - Street 2:
Practice Address - City:LONE ROCK
Practice Address - State:WI
Practice Address - Zip Code:53556-4149
Practice Address - Country:US
Practice Address - Phone:703-300-0145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-03
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556548111N00000X
DCCH030076111N00000X
WI4270-12111N00000X
COCHR-6008111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor