Provider Demographics
NPI:1417057050
Name:FEDORCHUK, CURTIS ALEXANDER (DC)
Entity Type:Individual
Prefix:DR
First Name:CURTIS
Middle Name:ALEXANDER
Last Name:FEDORCHUK
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 1:4955 CHEROKEE ROSE CT
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-1828
Mailing Address - Country:US
Mailing Address - Phone:678-314-9122
Mailing Address - Fax:
Practice Address - Street 1:131 MECHANIC ST
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-1337
Practice Address - Country:US
Practice Address - Phone:706-864-5362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO07276111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA944233617AMedicaid
GA120530OtherBCBS GA
GA35ZCJVBMedicare PIN
GA944233617AMedicaid