Healthcare Provider Details

I. General information

NPI: 1003246133
Provider Name (Legal Business Name): FAIRWOOD CHIROPRACTIC AND REHAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2013
Last Update Date: 11/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5215 MONROE ST SUITE 4
TOLEDO OH
43623-3190
US

IV. Provider business mailing address

5215 MONROE ST SUITE 4
TOLEDO OH
43623-3190
US

V. Phone/Fax

Practice location:
  • Phone: 419-843-1515
  • Fax: 419-715-9554
Mailing address:
  • Phone: 419-843-1515
  • Fax: 419-715-9554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4181
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4184
License Number StateOH

VIII. Authorized Official

Name: DR. JASON JAMES ROBERT PEISLEY
Title or Position: OWNER/CHIROPRACTOR
Credential: DC
Phone: 419-843-1515