Provider Demographics
NPI:1063066223
Name:FAHSHOLTZ, ANTHONY MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:MICHAEL
Last Name:FAHSHOLTZ
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 1:2965 WALNUT CT
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-6494
Mailing Address - Country:US
Mailing Address - Phone:509-860-3194
Mailing Address - Fax:
Practice Address - Street 1:106 W NORTH BLVD # 101
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5039
Practice Address - Country:US
Practice Address - Phone:425-035-2702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-26
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12853111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor