Provider Demographics
NPI:1942778063
Name:FIEGEL CHIROPRACTIC & WELLNESS CLINIC PC
Entity Type:Organization
Organization Name:FIEGEL CHIROPRACTIC & WELLNESS CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:E
Authorized Official - Last Name:FIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-882-3012
Mailing Address - Street 1:102 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-2842
Mailing Address - Country:US
Mailing Address - Phone:509-330-2018
Mailing Address - Fax:208-882-0396
Practice Address - Street 1:102 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-2842
Practice Address - Country:US
Practice Address - Phone:509-330-2018
Practice Address - Fax:208-882-0396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1265767347OtherNATIONAL PROVIDER IDENTIFICATION