Provider Demographics
NPI:1083793830
Name:FAIRFIELD SPINE CENTER,LLC
Entity Type:Organization
Organization Name:FAIRFIELD SPINE CENTER,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:GRILLIOT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:740-687-5002
Mailing Address - Street 1:1600 SHERIDAN DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-1305
Mailing Address - Country:US
Mailing Address - Phone:740-687-5002
Mailing Address - Fax:740-687-5003
Practice Address - Street 1:1600 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-1305
Practice Address - Country:US
Practice Address - Phone:740-687-5002
Practice Address - Fax:740-687-5003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH940111N00000X
OHOH1555111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOH0114683Medicaid
OHOH0716498Medicaid
OHOH0716498Medicaid
OHT48127Medicare UPIN
OHDEO0560413Medicare ID - Type UnspecifiedJAMES R. GRILLIOT
OHDEO0670081Medicare ID - Type UnspecifiedJAMES S. DEPIETRO