Provider Demographics
NPI:1407016421
Name:FAIRMONT CHIROPRACTIC & REHAB, LLC
Entity Type:Organization
Organization Name:FAIRMONT CHIROPRACTIC & REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:ANNUNZIATA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-275-1325
Mailing Address - Street 1:1600 QUEEN CITY AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45214-1600
Mailing Address - Country:US
Mailing Address - Phone:513-471-2225
Mailing Address - Fax:
Practice Address - Street 1:1600 QUEEN CITY AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45214-1600
Practice Address - Country:US
Practice Address - Phone:513-471-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC3438111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty