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General NPI Number Information
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NPI Number | 1891469599
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Entity Type | Individual
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Provider Name | ANTHONY WAYNE FAIRCHILD JR. DC
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Gender | Male
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Dates
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Enumeration Date | 08/05/2021
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Last Update Date | 08/05/2021
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Provider Practice Location Address
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Address Line | 100 STADIUM DR
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City | DEFIANCE
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State | OH
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Zip | 43512-4614
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Country | US
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Telephone | 419-439-2758
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Fax |
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Provider Business Mailing Address
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Address Line | 6149 GLENBURG RD
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City | DEFIANCE
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State | OH
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Zip | 43512-9773
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Country | US
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Telephone | 419-439-2758
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DC-05115
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License Number State | OH
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