Provider Demographics
NPI:1003246133
Name:FAIRWOOD CHIROPRACTIC AND REHAB, LLC
Entity Type:Organization
Organization Name:FAIRWOOD CHIROPRACTIC AND REHAB, LLC
Other - Org Name:FAIRWOOD CHIROPRACTIC AND PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:JAMES ROBERT
Authorized Official - Last Name:PEISLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-843-1515
Mailing Address - Street 1:5215 MONROE ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-3190
Mailing Address - Country:US
Mailing Address - Phone:419-843-1515
Mailing Address - Fax:419-715-9554
Practice Address - Street 1:5215 MONROE ST
Practice Address - Street 2:SUITE 4
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3190
Practice Address - Country:US
Practice Address - Phone:419-843-1515
Practice Address - Fax:419-715-9554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-27
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4181111N00000X
OH4184225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty