Fairbanks, Russell Austin

Fairbanks, Russell Austin is an individual health care provider with primary practice located at 408 N Third St , Rogers City MI 49779-1309. He recently has only one registered license in Chiropractic Providers / Chiropractor, which is considered as his primary health care specialty. Fairbanks, Russell Austin can be contacted via phone (989) 734-3384.

Contact Information

Primary practice address
408 N Third St Rogers City MI 49779-1309
Fax: (989) 734-7391
Website:

Health care specialties

SpecialtyCodeLicense #State
Chiropractic Providers / Chiropractor 111N00000X 2301005062 Michigan

Profile Details

NPI number 1528018355
LBN Legal business name Fairbanks, Russell Austin
Credentials Doctor of Chiropractic (DC)
Entity Individual
Sole proprietor 1 No
Enumeration date May 11th, 2006
Last updated Jun 14th, 2011 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1528018355 NPPES
Michigan MEDICAID 2967204
Michigan Other 95OG150000

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