Bradley Garrett Fairman, D.C.
Individual provider Active NPI Chiropractor · Berlin, PA
NPI 1104956986 · NPPES record last updated Oct 9, 2014
Key facts
- NPI
- 1104956986
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- DC009285 (PA)
- Practice address
- 537 Main St
Berlin, PA 15530-1344 - Phone
- (814) 267-6440
- Fax
- (814) 267-6442
- NPI assigned
- Mar 7, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DC009285 | PA | MD | Chiropractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | DC009285 | PA | Yes |
Addresses
Primary practice location
537 Main St
Berlin, PA 15530-1344
Mailing address
537 Main St
Berlin, PA 15530-1344
Phone (814) 267-6440
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001666144 | Other | PA | HIGHMARK PROVIDER ID |
Other providers in Berlin, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 9, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.