Provider Demographics
NPI:1467674440
Name:FAIRVIEW CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:FAIRVIEW CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:989-848-2265
Mailing Address - Street 1:PO BOX 174
Mailing Address - Street 2:1554 N ABBE RD
Mailing Address - City:FAIRVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48621-0174
Mailing Address - Country:US
Mailing Address - Phone:989-848-2265
Mailing Address - Fax:989-848-8003
Practice Address - Street 1:1554 N ABBE RD
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:MI
Practice Address - Zip Code:48621-8719
Practice Address - Country:US
Practice Address - Phone:989-848-2265
Practice Address - Fax:989-848-8003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI006520111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F85023OtherBCBS
MI4391387Medicaid
MI4391387Medicaid
MI0F85023OtherBCBS