Provider Demographics
NPI:1568119352
Name:GEBREMEDHIN, FISSEHA GEBREGZIABHER (DC)
Entity Type:Individual
Prefix:DR
First Name:FISSEHA
Middle Name:GEBREGZIABHER
Last Name:GEBREMEDHIN
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 1:10110 WALNUT ST APT 109
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-5156
Mailing Address - Country:US
Mailing Address - Phone:214-780-9777
Mailing Address - Fax:
Practice Address - Street 1:5335 W SUBLETT RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-1184
Practice Address - Country:US
Practice Address - Phone:817-890-9009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14490111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor