Provider Demographics
NPI:1508853854
Name:FELLOWS, RICHARD
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:FELLOWS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3704 BAYSHORE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CAPE MAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08204-3500
Mailing Address - Country:US
Mailing Address - Phone:609-886-7177
Mailing Address - Fax:609-886-8575
Practice Address - Street 1:3704 BAYSHORE RD
Practice Address - Street 2:
Practice Address - City:NORTH CAPE MAY
Practice Address - State:NJ
Practice Address - Zip Code:08204-3500
Practice Address - Country:US
Practice Address - Phone:609-886-7177
Practice Address - Fax:609-886-8575
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00344400111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
U19938Medicare UPIN
417270Medicare PIN