Healthcare Provider Details

I. General information

NPI: 1346370384
Provider Name (Legal Business Name): PETER J FAGERLAND D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 11/13/2022
Certification Date: 11/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 BOGGS LN STE 286
CINCINNATI OH
45246-3145
US

IV. Provider business mailing address

110 BOGGS LN STE 286
CINCINNATI OH
45246-3145
US

V. Phone/Fax

Practice location:
  • Phone: 513-742-0002
  • Fax: 513-239-8875
Mailing address:
  • Phone: 513-742-0002
  • Fax: 513-239-8875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number1696
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: