Organization
RUSSELL A FAIRBANKS, D.C.,P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUSSELL FAIRBANKS D.C. (PRESIDENT)
(989) 734-3384
Entity
Organization
Contact information
Practice address
408 N THIRD ST, ROGERS CITY, MI 49779-1309
(989) 734-3384
Mailing address
PO BOX 213, ROGERS CITY, MI 49779-0213
(989) 734-3384
(989) 734-7391
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2301005062
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2967204
—
MI
01
—
950G15000
BLUE CROSS
MI
Enumeration date
09/10/2010
Last updated
09/10/2010
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