Provider Demographics
NPI:1457345464
Name:FENELL, ROBERT JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOHN
Last Name:FENELL
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 1:3515 E 31ST STREET
Mailing Address - Street 2:B
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-3512
Mailing Address - Country:US
Mailing Address - Phone:918-749-4263
Mailing Address - Fax:888-505-9606
Practice Address - Street 1:3515 E 31ST STREET
Practice Address - Street 2:B
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135
Practice Address - Country:US
Practice Address - Phone:918-749-4263
Practice Address - Fax:888-505-9606
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3398111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKU71810Medicare UPIN