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General NPI Number Information
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NPI Number | 1407016421
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Entity Type | Organization
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Legal Business Name | FAIRMONT CHIROPRACTIC & REHAB, LLC
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Dates
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Enumeration Date | 06/12/2008
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Last Update Date | 06/12/2008
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Provider Practice Location Address
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Address Line | 1600 QUEEN CITY AVE 2ND FLOOR
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City | CINCINNATI
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State | OH
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Zip | 45214-1600
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Country | US
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Telephone | 513-471-2225
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 QUEEN CITY AVE 2ND FLOOR
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City | CINCINNATI
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State | OH
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Zip | 45214-1600
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Country | US
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Telephone | 513-471-2225
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | CHARLES ANNUNZIATA
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Credential |
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Telephone | 856-275-1325
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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 | DC3438
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License Number State | OH
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