Provider Demographics
NPI:1447939020
Name:FAGIN, KODY (DC)
Entity type:Individual
Prefix:DR
First Name:KODY
Middle Name:
Last Name:FAGIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2614 S ADAMS RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-5509
Mailing Address - Country:US
Mailing Address - Phone:248-897-0699
Mailing Address - Fax:
Practice Address - Street 1:2614 S ADAMS RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-5509
Practice Address - Country:US
Practice Address - Phone:248-897-0699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301401380111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor