Provider Demographics
NPI:1871556936
Name:FAIRMAN, KENNETH M (DC)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:M
Last Name:FAIRMAN
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 1:1325 HOWARD ST, SUITE 307
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3787
Mailing Address - Country:US
Mailing Address - Phone:847-328-1975
Mailing Address - Fax:847-328-1976
Practice Address - Street 1:1325 HOWARD ST, SUITE 307
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3787
Practice Address - Country:US
Practice Address - Phone:847-328-1975
Practice Address - Fax:847-328-1976
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU29282Medicare UPIN
ILK45557Medicare PIN