Healthcare Provider Details

I. General information

NPI: 1912971177
Provider Name (Legal Business Name): FAIRVIEW CHIROPRACTIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1136 US 31W BYP
BOWLING GREEN KY
42101-2420
US

IV. Provider business mailing address

PO BOX 70219
BOWLING GREEN KY
42102-4019
US

V. Phone/Fax

Practice location:
  • Phone: 270-843-2255
  • Fax: 270-782-2822
Mailing address:
  • Phone: 270-843-2255
  • Fax: 270-782-2822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3742
License Number StateKY

VIII. Authorized Official

Name: JOHN G ERSKINE
Title or Position: CHIROPRACTOR/OWNER
Credential: D.C.
Phone: 270-843-2255