MEDICARE: FAIRVIEW CHIROPRACTIC CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2407	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	605759	OTHER	NC	ACN
3	0832J	OTHER	NC	BCBS PROVIDER #
4	016X4	OTHER	NC	BCBS GROUP #
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376603993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAIRVIEW CHIROPRACTIC CENTER

Provider Business Mailing Address
First Line	:	2 FAIRVIEW HILLS DR
Second Line	:
City	:	FAIRVIEW
State	:	NC
Zip	:	28730-9777
Country	:	US
Telephone Number	:	828-628-7800
Fax Number	:	828-628-4328

Provider Business Practice Location Address
First Line	:	2 FAIRVIEW HILLS DR
Second Line	:
City	:	FAIRVIEW
State	:	NC
Zip	:	28730-9777
Country	:	US
Telephone Number	:	828-628-7800
Fax Number	:	828-628-4328

Authorized Official
Title or Position	:	OWNER
Name	:	DR. EDWARD G REILLY
Credential	:	D.C.
Telephone Number	:	828-628-7800

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	08/22/2020

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Practice Location Address:

2 FAIRVIEW HILLS DR
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28730-9777

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28730-9777

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Practice Location Address:

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28730-9777

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1053338012 — MYERS OPTICAL CENTER INC.
Practice Location Address:

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Directions to “FAIRVIEW CHIROPRACTIC CENTER ” Practice Location

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