Provider Demographics
NPI:1205991098
Name:FAIRCHILD, PATRICK DANIEL (DC)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:DANIEL
Last Name:FAIRCHILD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9381
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92552
Mailing Address - Country:US
Mailing Address - Phone:951-656-1413
Mailing Address - Fax:951-656-7724
Practice Address - Street 1:23890 ALESSANDRO BLVD SUITE F
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:82553
Practice Address - Country:US
Practice Address - Phone:951-656-1413
Practice Address - Fax:951-656-7724
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14022111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHC040171OtherXRAY OPERATOR LICENSE
CARHC040171OtherXRAY OPERATOR LICENSE