Provider Demographics
NPI:1790708170
Name:FIENI, JEREMY DANIEL (DC)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:DANIEL
Last Name:FIENI
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 1:2371 BUCHANAN TRL W
Mailing Address - Street 2:
Mailing Address - City:GREENCASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:17225-8306
Mailing Address - Country:US
Mailing Address - Phone:717-263-9979
Mailing Address - Fax:717-263-9008
Practice Address - Street 1:2371 BUCHANAN TRL W
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:PA
Practice Address - Zip Code:17225-8306
Practice Address - Country:US
Practice Address - Phone:717-263-9979
Practice Address - Fax:717-263-9008
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009307111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAV07071Medicare UPIN