Provider Demographics
NPI:1790875201
Name:FELLA, ELEANOR (DC)
Entity Type:Individual
Prefix:DR
First Name:ELEANOR
Middle Name:
Last Name:FELLA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:ELEANOR
Other - Middle Name:
Other - Last Name:MERRILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:2420 MADEIRA CIR
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-6227
Mailing Address - Country:US
Mailing Address - Phone:845-222-4540
Mailing Address - Fax:
Practice Address - Street 1:2420 MADEIRA CIR
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-6227
Practice Address - Country:US
Practice Address - Phone:845-222-4540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4224111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX4T191OtherBCBS PIN
NYX4T191OtherBCBS PIN