Provider Demographics
NPI:1871746008
Name:FIELDS CHIROPRACTIC CLINIC, LLC
Entity type:Organization
Organization Name:FIELDS CHIROPRACTIC CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:N
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-452-6123
Mailing Address - Street 1:PO BOX 1309
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31059-1309
Mailing Address - Country:US
Mailing Address - Phone:478-452-2411
Mailing Address - Fax:478-452-7644
Practice Address - Street 1:425 N COBB ST
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-2634
Practice Address - Country:US
Practice Address - Phone:478-452-2411
Practice Address - Fax:478-452-7644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty