Provider Demographics
NPI:1114586492
Name:FAGAN CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:FAGAN CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEALAND
Authorized Official - Middle Name:K
Authorized Official - Last Name:FAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-457-2045
Mailing Address - Street 1:900 E RUTHERFORD ST
Mailing Address - Street 2:
Mailing Address - City:LANDRUM
Mailing Address - State:SC
Mailing Address - Zip Code:29356-1725
Mailing Address - Country:US
Mailing Address - Phone:864-316-4611
Mailing Address - Fax:864-551-2945
Practice Address - Street 1:900 E RUTHERFORD ST
Practice Address - Street 2:
Practice Address - City:LANDRUM
Practice Address - State:SC
Practice Address - Zip Code:29356-1725
Practice Address - Country:US
Practice Address - Phone:864-316-4611
Practice Address - Fax:864-551-2945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty