Healthcare Provider Details

I. General information

NPI: 1316147200
Provider Name (Legal Business Name): FAIRMONT CHIROPRACTIC & ACUPUNCTURE HEALTHCARE, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 08/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 SPRUCE ST
FAIRMONT MN
56031-4410
US

IV. Provider business mailing address

1125 SPRUCE ST
FAIRMONT MN
56031-4410
US

V. Phone/Fax

Practice location:
  • Phone: 507-235-6629
  • Fax: 507-235-6620
Mailing address:
  • Phone: 507-235-6629
  • Fax: 507-235-6620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2034
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: CAROL E OLSON
Title or Position: RECEPTIONIST
Credential:
Phone: 507-235-6629