Provider Demographics
NPI:1336736420
Name:FENENBOCK, ADAM MARCUS (DC)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:MARCUS
Last Name:FENENBOCK
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 1:175 W 400 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-4658
Mailing Address - Country:US
Mailing Address - Phone:801-607-2707
Mailing Address - Fax:801-607-1939
Practice Address - Street 1:175 W 400 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-4658
Practice Address - Country:US
Practice Address - Phone:801-607-2707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-23
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT6736111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty