Provider Demographics
NPI:1285680629
Name:FEDIAY, PETER (DC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:FEDIAY
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 1:2904 FREEDOM BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CORRALITOS
Mailing Address - State:CA
Mailing Address - Zip Code:95076-0469
Mailing Address - Country:US
Mailing Address - Phone:831-728-5151
Mailing Address - Fax:831-728-5155
Practice Address - Street 1:2904 FREEDOM BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:CORRALITOS
Practice Address - State:CA
Practice Address - Zip Code:95076-0469
Practice Address - Country:US
Practice Address - Phone:831-728-5151
Practice Address - Fax:831-728-5155
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12663111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor