Provider Demographics
NPI:1497715569
Name:FEDORE, ROBERT NATHAN (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:NATHAN
Last Name:FEDORE
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 1:2121 RICHMOND RD
Mailing Address - Street 2:SUITE 226
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-1206
Mailing Address - Country:US
Mailing Address - Phone:859-309-9268
Mailing Address - Fax:859-309-9268
Practice Address - Street 1:2121 RICHMOND RD
Practice Address - Street 2:SUITE 226
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-1206
Practice Address - Country:US
Practice Address - Phone:859-309-9268
Practice Address - Fax:859-309-9268
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5083111N00000X
FLCH8901111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHFE4184551Medicare PIN
OHVO5252Medicare UPIN