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General NPI Number Information
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NPI Number | 1043383888
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Entity Type | Organization
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Legal Business Name | FAIRLEA CHIROPRATIC CLINIC
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 325 SENECA TR
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City | RONCEVERTE
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State | WV
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Zip | 24970
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Country | US
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Telephone | 304-645-6524
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Fax | 304-645-6524
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Provider Business Mailing Address
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Address Line | 325 SENECA TR
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City | RONCEVERTE
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State | WV
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Zip | 24970
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Country | US
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Telephone | 304-645-6524
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Fax | 304-645-6524
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Authorized Official
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Title or Position | PRES
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Name | MR. HAROLD RAYMOND FLESCHNER
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Credential | DC
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Telephone | 304-645-6524
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 363
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License Number State | WV
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