Provider Demographics
NPI:1912971177
Name:FAIRVIEW CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:FAIRVIEW CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:ERSKINE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:270-843-2255
Mailing Address - Street 1:PO BOX 70219
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42102-4019
Mailing Address - Country:US
Mailing Address - Phone:270-843-2255
Mailing Address - Fax:270-782-2822
Practice Address - Street 1:1136 US 31W BYP
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-2420
Practice Address - Country:US
Practice Address - Phone:270-843-2255
Practice Address - Fax:270-782-2822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3742111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000051365OtherANTHEM BC/BS
KY1829001Medicare ID - Type Unspecified
KY000000051365OtherANTHEM BC/BS