Provider Demographics
NPI:1477747061
Name:SCOTT FECHTER CHIROPRACTIC INC
Entity Type:Organization
Organization Name:SCOTT FECHTER CHIROPRACTIC INC
Other - Org Name:ST AUGUSTINE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:FECHTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-377-6199
Mailing Address - Street 1:2550 US 1 S
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-6194
Mailing Address - Country:US
Mailing Address - Phone:904-823-8833
Mailing Address - Fax:904-823-9394
Practice Address - Street 1:2550 US 1 S
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-6194
Practice Address - Country:US
Practice Address - Phone:904-823-8833
Practice Address - Fax:904-823-9394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8582111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5361Medicare PIN