Provider Demographics
NPI:1083375802
Name:FAIRCHILD FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:FAIRCHILD FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:FAIRCHILD
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:419-439-2758
Mailing Address - Street 1:100 STADIUM DR STE B
Mailing Address - Street 2:
Mailing Address - City:DEFIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:43512-4615
Mailing Address - Country:US
Mailing Address - Phone:419-576-5070
Mailing Address - Fax:
Practice Address - Street 1:100 STADIUM DR STE B
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-4615
Practice Address - Country:US
Practice Address - Phone:419-576-5070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty