Provider Demographics
NPI:1497337216
Name:FAIRLEY CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:FAIRLEY CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FAIRLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:510-328-1381
Mailing Address - Street 1:3825 MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-1361
Mailing Address - Country:US
Mailing Address - Phone:510-328-1381
Mailing Address - Fax:844-273-4643
Practice Address - Street 1:3825 MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94619-1361
Practice Address - Country:US
Practice Address - Phone:510-328-1381
Practice Address - Fax:844-273-4643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty