Provider Demographics
NPI:1043729262
Name:FARGO, NABEEL (DC)
Entity type:Individual
Prefix:DR
First Name:NABEEL
Middle Name:
Last Name:FARGO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:NABEEL
Other - Middle Name:
Other - Last Name:FARGO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:6281 BROCKTON AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2210
Mailing Address - Country:US
Mailing Address - Phone:951-313-0056
Mailing Address - Fax:
Practice Address - Street 1:6281 BROCKTON AVE STE 5
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2210
Practice Address - Country:US
Practice Address - Phone:951-313-0056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33808111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor