Provider Demographics
NPI:1245460864
Name:FELLA FAMILY CHIROPRACTIC AND WELLNESS, PLLC
Entity type:Organization
Organization Name:FELLA FAMILY CHIROPRACTIC AND WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELEANOR
Authorized Official - Middle Name:
Authorized Official - Last Name:FELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:845-592-2803
Mailing Address - Street 1:2421 ROUTE 52
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12533-3211
Mailing Address - Country:US
Mailing Address - Phone:845-592-2803
Mailing Address - Fax:
Practice Address - Street 1:2421 ROUTE 52
Practice Address - Street 2:
Practice Address - City:HOPEWELL JUNCTION
Practice Address - State:NY
Practice Address - Zip Code:12533-3211
Practice Address - Country:US
Practice Address - Phone:845-592-2803
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010245-2111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYXJW741Medicare PIN