Individual
DAVID LEE FAIRBANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
510 S 9TH ST, GLADSTONE, MI 49837-1613
(906) 428-1679
(906) 428-4643
Mailing address
510 S 9TH ST, GLADSTONE, MI 49837-1613
(906) 428-1679
(906) 428-4643
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2301005132
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4356207
—
MI
01
—
950B15004
INDIVIDUAL BCBS #
MI
Enumeration date
01/08/2007
Last updated
01/14/2014
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