Provider Demographics
NPI:1710100458
Name:FAIRMAN FAMILY CHIROPRACTIC P C
Entity Type:Organization
Organization Name:FAIRMAN FAMILY CHIROPRACTIC P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:GARRETT
Authorized Official - Last Name:FAIRMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:814-267-6440
Mailing Address - Street 1:537 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:PA
Mailing Address - Zip Code:15530-1344
Mailing Address - Country:US
Mailing Address - Phone:814-267-6440
Mailing Address - Fax:814-267-6442
Practice Address - Street 1:537 MAIN ST
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:PA
Practice Address - Zip Code:15530-1344
Practice Address - Country:US
Practice Address - Phone:814-267-6440
Practice Address - Fax:814-267-6442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009285111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1951171OtherHIGHMARK BC/BS