Provider Demographics
NPI:1639238637
Name:FELDENHEIMER, SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:FELDENHEIMER
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 1:354 NE NORTON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4392
Mailing Address - Country:US
Mailing Address - Phone:541-385-5900
Mailing Address - Fax:541-389-1972
Practice Address - Street 1:354 NE NORTON AVE STE 100
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4392
Practice Address - Country:US
Practice Address - Phone:541-385-5900
Practice Address - Fax:541-389-1972
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 3182111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR93-1286550OtherFEDERAL TAX ID
OR93-1286550OtherFEDERAL TAX ID