Provider Demographics
NPI:1003836826
Name:FENELUS, PATRICK LOUIS (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:LOUIS
Last Name:FENELUS
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 1:4121 NW 5TH ST
Mailing Address - Street 2:STE 215
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2120
Mailing Address - Country:US
Mailing Address - Phone:954-358-0301
Mailing Address - Fax:954-316-4547
Practice Address - Street 1:4121 NW 5TH ST
Practice Address - Street 2:STE 215
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2120
Practice Address - Country:US
Practice Address - Phone:954-358-0301
Practice Address - Fax:954-316-4547
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8094111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22949ZMedicare ID - Type UnspecifiedPROVIDER IDENTIFICATION
FLV05526Medicare UPIN