Provider Demographics
NPI:1760530430
Name:FAIRBANKS FAMILY CHIROPRACTIC INC
Entity Type:Organization
Organization Name:FAIRBANKS FAMILY CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARGO
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:FAIRBANKS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:906-428-1679
Mailing Address - Street 1:510 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:MI
Mailing Address - Zip Code:49837-1613
Mailing Address - Country:US
Mailing Address - Phone:906-428-1679
Mailing Address - Fax:906-428-1679
Practice Address - Street 1:510 S 9TH ST
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:MI
Practice Address - Zip Code:49837-1613
Practice Address - Country:US
Practice Address - Phone:906-428-1679
Practice Address - Fax:906-428-1679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950B11014OtherBCBS GROUP #
MI950B11014OtherBCBS GROUP #