Provider Demographics
NPI:1558568907
Name:FIELDS CHIROPRACTIC FAMILY PRACTICE INC.
Entity type:Organization
Organization Name:FIELDS CHIROPRACTIC FAMILY PRACTICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:DC,DACS
Authorized Official - Phone:419-474-8000
Mailing Address - Street 1:4405 TALMADGE RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-3509
Mailing Address - Country:US
Mailing Address - Phone:419-474-8000
Mailing Address - Fax:419-474-1700
Practice Address - Street 1:4405 TALMADGE RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623
Practice Address - Country:US
Practice Address - Phone:419-474-8000
Practice Address - Fax:419-474-1700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH964111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHT47829Medicare UPIN