Provider Demographics
NPI:1336284173
Name:FELCH, KENNETH WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:WILLIAM
Last Name:FELCH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:KEN
Other - Middle Name:WILLIAM
Other - Last Name:FELCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:644 FREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-4812
Mailing Address - Country:US
Mailing Address - Phone:650-948-8900
Mailing Address - Fax:650-948-8827
Practice Address - Street 1:644 FREMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-4812
Practice Address - Country:US
Practice Address - Phone:650-948-8900
Practice Address - Fax:650-948-8827
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28786111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ06912ZOtherGROUP PTAN
CAU95992Medicare UPIN