Provider Demographics
NPI:1881663235
Name:FEDINA, JOHN ALPHONSO (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALPHONSO
Last Name:FEDINA
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 1:4240 N BLACKSTOCK RD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-1112
Mailing Address - Country:US
Mailing Address - Phone:864-574-4577
Mailing Address - Fax:
Practice Address - Street 1:4240 N BLACKSTOCK RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-1112
Practice Address - Country:US
Practice Address - Phone:864-574-4577
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1042111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician