Provider Demographics
NPI:1649243791
Name:FEDER, PATRICK D (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:D
Last Name:FEDER
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 1:113 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025-1109
Mailing Address - Country:US
Mailing Address - Phone:636-938-9310
Mailing Address - Fax:636-938-3204
Practice Address - Street 1:113 W 5TH ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MO
Practice Address - Zip Code:63025-1109
Practice Address - Country:US
Practice Address - Phone:636-938-9310
Practice Address - Fax:636-938-3204
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006495111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00261603OtherMEDICARE RAILROAD
MOU67511OtherMERCY
MO106922OtherBLUE CROSS BLUE SHIELD
MO5538504OtherAETNA
MO143427OtherGHP
MO1003910OtherASHN
MO1941775OtherPHCS
MO293271OtherHEALTHLINK
MO143427OtherGHP