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Individual

DR. RUSSELL AUSTIN FAIRBANKS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.C.

Contact information

Practice address
408 N THIRD ST, ROGERS CITY, MI 49779-1309
(989) 734-3384
(989) 734-7391
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
95OG150000
BLUE CROSSBLUESHIELD
MI
Enumeration date
05/11/2006
Last updated
06/14/2011
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