MEDICARE: FAIRVIEW PARK CHIROPRACTIC CENTER, INC.

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	2984	OH

General Provider Information

NPI Number	:	1639359490
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAIRVIEW PARK CHIROPRACTIC CENTER, INC.

Provider Business Mailing Address
First Line	:	21881 LORAIN RD
Second Line	:
City	:	FAIRVIEW PARK
State	:	OH
Zip	:	44126-3330
Country	:	US
Telephone Number	:	440-331-9033
Fax Number	:

Provider Business Practice Location Address
First Line	:	21881 LORAIN RD
Second Line	:
City	:	FAIRVIEW PARK
State	:	OH
Zip	:	44126-3330
Country	:	US
Telephone Number	:	440-331-9033
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. TODD W SMITH
Credential	:	D.C.
Telephone Number	:	440-331-9033

Provider Enumeration Date	:	11/09/2007
Last Update Date	:	11/09/2007

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