Provider Demographics
NPI:1982082707
Name:FAIRFIELD CHIROPRACTIC CLINIC LLC
Entity Type:Organization
Organization Name:FAIRFIELD CHIROPRACTIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:MEEKS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-842-6086
Mailing Address - Street 1:1111 W DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62837-2315
Mailing Address - Country:US
Mailing Address - Phone:618-842-6086
Mailing Address - Fax:618-842-6086
Practice Address - Street 1:1111 W DELAWARE ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IL
Practice Address - Zip Code:62837-2315
Practice Address - Country:US
Practice Address - Phone:618-842-6086
Practice Address - Fax:618-842-6086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012107111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty