Provider Demographics
NPI:1619904026
Name:FENN, JAMES RYAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RYAN
Last Name:FENN
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 1:1989 CAPITAL CIR NE
Mailing Address - Street 2:STE 1
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4493
Mailing Address - Country:US
Mailing Address - Phone:850-386-7700
Mailing Address - Fax:850-386-7722
Practice Address - Street 1:1989 CAPITAL CIR NE
Practice Address - Street 2:STE 1
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4493
Practice Address - Country:US
Practice Address - Phone:850-386-7700
Practice Address - Fax:850-386-7722
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7993111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4509Medicare ID - Type Unspecified