Provider Demographics
NPI:1568016004
Name:FENTON CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:FENTON CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:FENTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:205-375-2959
Mailing Address - Street 1:PO BOX 340
Mailing Address - Street 2:
Mailing Address - City:REFORM
Mailing Address - State:AL
Mailing Address - Zip Code:35481-0340
Mailing Address - Country:US
Mailing Address - Phone:205-375-2959
Mailing Address - Fax:205-469-8014
Practice Address - Street 1:301 1ST ST S
Practice Address - Street 2:
Practice Address - City:REFORM
Practice Address - State:AL
Practice Address - Zip Code:35481-8013
Practice Address - Country:US
Practice Address - Phone:205-375-2959
Practice Address - Fax:205-469-8014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care