Provider Demographics
NPI:1790408375
Name:FENTON, SYDNEY KAY (DC)
Entity Type:Individual
Prefix:DR
First Name:SYDNEY
Middle Name:KAY
Last Name:FENTON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 CENTRAL AVE APT 330
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-5192
Mailing Address - Country:US
Mailing Address - Phone:812-664-6181
Mailing Address - Fax:
Practice Address - Street 1:2317 RANDOLPH RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1525
Practice Address - Country:US
Practice Address - Phone:704-317-2706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5538111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor