Provider Demographics
NPI:1184616641
Name:RONALD J. FARABAUGH DC, INC.
Entity type:Organization
Organization Name:RONALD J. FARABAUGH DC, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:FARABAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:614-898-0787
Mailing Address - Street 1:2879 E DUBLIN GRANVILLE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-4063
Mailing Address - Country:US
Mailing Address - Phone:614-898-0787
Mailing Address - Fax:614-898-1945
Practice Address - Street 1:2879 E DUBLIN GRANVILLE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-4063
Practice Address - Country:US
Practice Address - Phone:614-898-0787
Practice Address - Fax:614-898-1945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3799111N00000X
OH1746111N00000X
OH939111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH28676858700OtherBWC
OH0861090Medicaid
OH1746OtherLICENSE
OH29774467900OtherBWC
OH939OtherLICENSE
OHRO9300211OtherMEDICARE GROUP #
OH3799OtherLICENSE
OH0496922Medicaid
OH17750858200OtherBWC
OH2117024Medicaid
OH0496922Medicaid
OH2117024Medicaid
OHRO9300211OtherMEDICARE GROUP #
OH939OtherLICENSE
OH29774467900OtherBWC
OHT47620Medicare UPIN