Provider Demographics
NPI:1487881835
Name:FABIAN, NICHOLAS MICHAEL (DC)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:MICHAEL
Last Name:FABIAN
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 1:710 LEONA ST
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-2349
Mailing Address - Country:US
Mailing Address - Phone:440-324-0092
Mailing Address - Fax:440-324-0093
Practice Address - Street 1:4365 LIBERTY AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:VERMILION
Practice Address - State:OH
Practice Address - Zip Code:44089-2133
Practice Address - Country:US
Practice Address - Phone:440-967-4226
Practice Address - Fax:440-967-0296
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3994111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor