Provider Demographics
NPI:1811140031
Name:FAIR PARK, P.L.L.C.
Entity type:Organization
Organization Name:FAIR PARK, P.L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAZAGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-708-8886
Mailing Address - Street 1:2910 S. UNIVERSITY AVE.
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204
Mailing Address - Country:US
Mailing Address - Phone:501-562-4900
Mailing Address - Fax:501-562-4905
Practice Address - Street 1:2910 S. UNIVERSITY AVE.
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204
Practice Address - Country:US
Practice Address - Phone:501-562-4900
Practice Address - Fax:501-562-4905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty