Provider Demographics
NPI:1538252101
Name:FAIRCHILD, DALE ANNETTE (DC)
Entity type:Individual
Prefix:DR
First Name:DALE
Middle Name:ANNETTE
Last Name:FAIRCHILD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430
Mailing Address - Country:US
Mailing Address - Phone:201-445-8091
Mailing Address - Fax:201-445-2950
Practice Address - Street 1:93 FRANKLIN TURNPIKE
Practice Address - Street 2:
Practice Address - City:WALDWICK
Practice Address - State:NJ
Practice Address - Zip Code:07463
Practice Address - Country:US
Practice Address - Phone:201-445-8091
Practice Address - Fax:201-445-2950
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2613111N00000X
CO4112111N00000X
GACHIR008084111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJFA456375Medicare ID - Type Unspecified