Provider Demographics
NPI:1407374150
Name:FEHMEL FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:FEHMEL FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:MARIAM
Authorized Official - Last Name:FEHMEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:912-659-4787
Mailing Address - Street 1:7309 LAZY HAMMOCK WAY
Mailing Address - Street 2:
Mailing Address - City:FLOWERY BRANCH
Mailing Address - State:GA
Mailing Address - Zip Code:30542-7730
Mailing Address - Country:US
Mailing Address - Phone:912-659-4787
Mailing Address - Fax:
Practice Address - Street 1:635 GREEN ST NW
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3319
Practice Address - Country:US
Practice Address - Phone:678-450-1570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-01
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007630111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty