Provider Demographics
NPI:1740517978
Name:FAIRFAX CHIROPRACTIC CENTER PLLC
Entity type:Organization
Organization Name:FAIRFAX CHIROPRACTIC CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAVIS
Authorized Official - Middle Name:O
Authorized Official - Last Name:GARRINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-845-2300
Mailing Address - Street 1:324 80TH ST CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:IA
Mailing Address - Zip Code:52228-9540
Mailing Address - Country:US
Mailing Address - Phone:319-845-2300
Mailing Address - Fax:319-845-2302
Practice Address - Street 1:324 80TH ST CT
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:IA
Practice Address - Zip Code:52228-9540
Practice Address - Country:US
Practice Address - Phone:319-845-2300
Practice Address - Fax:319-845-2302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA7208111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty