Provider Demographics
NPI:1679583165
Name:FEREDAY, BRIAN D (DC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:D
Last Name:FEREDAY
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:PO BOX 123
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:IA
Mailing Address - Zip Code:50674-0123
Mailing Address - Country:US
Mailing Address - Phone:563-578-8754
Mailing Address - Fax:
Practice Address - Street 1:108 W 1ST ST
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:IA
Practice Address - Zip Code:50674-1141
Practice Address - Country:US
Practice Address - Phone:563-578-8754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06141111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAU72559Medicare UPIN