Provider Demographics
NPI:1336281385
Name:FEDELE JR, STEPHEN (CHIROPRACTOR)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:FEDELE JR
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4677 N CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-1002
Mailing Address - Country:US
Mailing Address - Phone:559-229-1700
Mailing Address - Fax:559-229-1716
Practice Address - Street 1:4677 N CEDAR AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-1002
Practice Address - Country:US
Practice Address - Phone:559-229-1700
Practice Address - Fax:559-229-1716
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10306111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor