NPIMap

Organization Active NPI

Fairwood Chiropractic and Rehab, LLC

  • Chiropractor
  • Toledo, OH
National Provider Identifier
1003246133
Registry record updated Nov 27, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
4181 Issued in OH
Legal business name
FAIRWOOD CHIROPRACTIC AND REHAB, LLC
Practice address
5215 Monroe St
Suite 4
Toledo, OH 43623-3190
Phone
(419) 843-1515
Fax
(419) 715-9554
NPI assigned
Nov 27, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jason James Robert Peisley, DCNPI 1851684948
Title
Owner/Chiropractor
Phone
(419) 843-1515

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X 4181 OH Primary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X 4184 OH

Addresses

Primary practice location

5215 Monroe St
Suite 4
Toledo, OH 43623-3190

Mailing address

5215 Monroe St
Suite 4
Toledo, OH 43623-3190
Phone (419) 843-1515

Other names 1

  • Fairwood Chiropractic and Physical Therapy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131226000184 OH Part B Supplier - Clinic/Group Practice 4587891312 Receives reassigned benefits from 3 practitioners
Practice locations: Toledo, OH

National Provider Directory

National Provider Directory

Locations

5215 Monroe St
Ste 4
Toledo, OH 43623
Phone (419) 843-1515

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1385510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1385510400000",
    "number": "1003246133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5215 MONROE ST",
            "address_2": "SUITE 4",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436233190",
            "telephone_number": "419-843-1515",
            "fax_number": "419-715-9554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5215 MONROE ST",
            "address_2": "SUITE 4",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436233190",
            "telephone_number": "419-843-1515",
            "fax_number": "419-715-9554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRWOOD CHIROPRACTIC AND REHAB, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-27",
        "last_updated": "2013-11-27",
        "status": "A",
        "authorized_official_last_name": "PEISLEY",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "JAMES ROBERT",
        "authorized_official_title_or_position": "OWNER/CHIROPRACTOR",
        "authorized_official_telephone_number": "419-843-1515",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "OH",
            "license": "4181",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "OH",
            "license": "4184",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fairwood Chiropractic and Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Toledo, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.