Provider Demographics
NPI:1811234883
Name:FENTON CHIROPRACTIC PA
Entity Type:Organization
Organization Name:FENTON CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:J
Authorized Official - Last Name:FENTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-635-7400
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28681-0429
Mailing Address - Country:US
Mailing Address - Phone:828-635-7400
Mailing Address - Fax:828-635-7415
Practice Address - Street 1:101 7TH ST SW
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28681-2409
Practice Address - Country:US
Practice Address - Phone:828-635-7400
Practice Address - Fax:828-635-7415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2041111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCEWNA78OtherACN
NC561971088OtherHNS
0822GOtherBCBS
NC890822GMedicaid
NCEWNA78OtherACN