Individual
DR. ROBERT A. DEFAZIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
4050 W RAY RD STE 18, CHANDLER, AZ 85226-7256
(480) 206-9104
Mailing address
4050 W RAY RD # 17-158, CHANDLER, AZ 85226-7256
(480) 206-9104
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
6091
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0944220
BLUE CROSS PIN#
AZ
Enumeration date
03/29/2007
Last updated
07/08/2007
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