Provider Demographics
NPI:1538505417
Name:FAIR CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:FAIR CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNTER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:B
Authorized Official - Last Name:FAIR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:316-804-7095
Mailing Address - Street 1:2305 S. KANSAS AVE.
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114
Mailing Address - Country:US
Mailing Address - Phone:316-804-7095
Mailing Address - Fax:316-804-7095
Practice Address - Street 1:2305 S. KANSAS AVE.
Practice Address - Street 2:SUITE 104
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114
Practice Address - Country:US
Practice Address - Phone:316-804-7095
Practice Address - Fax:316-804-7095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-17
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA1794002Medicare PIN