Provider Demographics
NPI:1629299136
Name:FAIRWAY CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:FAIRWAY CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:LEAGO
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:281-331-5000
Mailing Address - Street 1:301 GLADE BRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-4162
Mailing Address - Country:US
Mailing Address - Phone:281-309-0776
Mailing Address - Fax:
Practice Address - Street 1:1701 FAIRWAY DR
Practice Address - Street 2:SUITE 2A
Practice Address - City:ALVIN
Practice Address - State:TX
Practice Address - Zip Code:77511-4661
Practice Address - Country:US
Practice Address - Phone:281-331-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9862111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty