Provider Demographics
NPI:1720161557
Name:FELT, KENNETH ALAN (DC)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:ALAN
Last Name:FELT
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:PO BOX 121044
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34712-1044
Mailing Address - Country:US
Mailing Address - Phone:352-394-5100
Mailing Address - Fax:352-394-0122
Practice Address - Street 1:1101 CITRUS TOWER BLVD
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711
Practice Address - Country:US
Practice Address - Phone:352-394-5100
Practice Address - Fax:352-394-0122
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0004724111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380244200Medicaid
FL70503Medicare ID - Type Unspecified