Provider Demographics
NPI:1619183498
Name:DAVID JOHN FAKADEJ DC INC
Entity Type:Organization
Organization Name:DAVID JOHN FAKADEJ DC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:FAKADEJ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:440-543-2771
Mailing Address - Street 1:17652 MUNN RD
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-5425
Mailing Address - Country:US
Mailing Address - Phone:440-543-2772
Mailing Address - Fax:440-543-2772
Practice Address - Street 1:17652 MUNN RD
Practice Address - Street 2:
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44023-5425
Practice Address - Country:US
Practice Address - Phone:440-543-2772
Practice Address - Fax:440-543-2772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3156111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2265972Medicaid
OH341964854-00OtherWORK COMP GROUP NUMBER
OH341964854-00OtherWORK COMP GROUP NUMBER
OH341964854-00OtherWORK COMP GROUP NUMBER
OHDASP02251Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
OHU86481Medicare UPIN