Provider Demographics
NPI:1184098972
Name:FAIRBANK CHIROPRACTIC LLC
Entity type:Organization
Organization Name:FAIRBANK CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:STEINBRONN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-849-5155
Mailing Address - Street 1:114 FOREST ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:FAIRBANK
Mailing Address - State:IA
Mailing Address - Zip Code:50629-7713
Mailing Address - Country:US
Mailing Address - Phone:319-849-5155
Mailing Address - Fax:
Practice Address - Street 1:114 FOREST ST
Practice Address - Street 2:SUITE 6
Practice Address - City:FAIRBANK
Practice Address - State:IA
Practice Address - Zip Code:50629-7713
Practice Address - Country:US
Practice Address - Phone:319-849-5155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-17
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA080259111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty