Provider Demographics
NPI:1346370384
Name:FAGERLAND, PETER J (DC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:J
Last Name:FAGERLAND
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 BOGGS LN STE 286
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-3145
Mailing Address - Country:US
Mailing Address - Phone:513-742-0002
Mailing Address - Fax:513-239-8875
Practice Address - Street 1:110 BOGGS LN STE 286
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-3145
Practice Address - Country:US
Practice Address - Phone:513-742-0002
Practice Address - Fax:513-239-8875
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2022-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1696111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU49788Medicare UPIN
OHTR9268821Medicare ID - Type Unspecified