Healthcare Provider Details

I. General information

NPI: 1245651959
Provider Name (Legal Business Name): FAIRFIELD SPINE AND REHAB CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2013
Last Update Date: 12/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2217 W FAIR AVE
LANCASTER OH
43130-8821
US

IV. Provider business mailing address

2217 W FAIR AVE
LANCASTER OH
43130-8821
US

V. Phone/Fax

Practice location:
  • Phone: 740-654-3375
  • Fax: 740-654-3985
Mailing address:
  • Phone: 740-654-3375
  • Fax: 740-654-3985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number1555
License Number StateOH

VIII. Authorized Official

Name: DR. JAMES S DEPIETRO
Title or Position: CHIROPRACTOR/OWNER
Credential: D.C.
Phone: 740-654-3375