Provider Demographics
NPI:1568698686
Name:FAIRCHILD, STEFANIE MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:STEFANIE
Middle Name:MARIE
Last Name:FAIRCHILD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:STEFANIE
Other - Middle Name:MARIE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 211247
Mailing Address - Street 2:
Mailing Address - City:AUKE BAY
Mailing Address - State:AK
Mailing Address - Zip Code:99821-1247
Mailing Address - Country:US
Mailing Address - Phone:907-500-4888
Mailing Address - Fax:907-790-4222
Practice Address - Street 1:2215 JORDAN AVE
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-8050
Practice Address - Country:US
Practice Address - Phone:907-500-4888
Practice Address - Fax:907-891-7376
Is Sole Proprietor?:No
Enumeration Date:2009-06-03
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK517111N00000X, 111N00000X
OK3945111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCH0104Medicaid
AKK106107Medicare UPIN