Provider Demographics
NPI:1720676026
Name:FAUST, BLAIR DANIEL (DC)
Entity type:Individual
Prefix:
First Name:BLAIR
Middle Name:DANIEL
Last Name:FAUST
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 1:575 MONTOUR BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-8509
Mailing Address - Country:US
Mailing Address - Phone:570-560-0585
Mailing Address - Fax:
Practice Address - Street 1:575 MONTOUR BLVD STE 5
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-8509
Practice Address - Country:US
Practice Address - Phone:570-560-0585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-04
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor