Healthcare Provider Details

I. General information

NPI: 1376603993
Provider Name (Legal Business Name): FAIRVIEW CHIROPRACTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 FAIRVIEW HILLS DR
FAIRVIEW NC
28730-9777
US

IV. Provider business mailing address

2 FAIRVIEW HILLS DR
FAIRVIEW NC
28730-9777
US

V. Phone/Fax

Practice location:
  • Phone: 828-628-7800
  • Fax: 828-628-4328
Mailing address:
  • Phone: 828-628-7800
  • Fax: 828-628-4328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2407
License Number StateNC

VIII. Authorized Official

Name: DR. EDWARD G REILLY
Title or Position: OWNER
Credential: D.C.
Phone: 828-628-7800