Individual
JACK E FAUBION
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
405 W BOXELDER RD, SUITE A1, GILLETTE, WY 82718-5320
(307) 685-2225
(307) 685-6436
Mailing address
405 W BOXELDER RD, SUITE A1, GILLETTE, WY 82718-5320
(307) 685-2225
(307) 685-6436
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
602
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
311379
BLUE CROSS BLUE SHIELD
WY
Enumeration date
12/14/2006
Last updated
07/08/2007
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