Provider Demographics
NPI:1770158743
Name:FESSEL CHIROPRACTIC INC.
Entity type:Organization
Organization Name:FESSEL CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:FESSEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:760-505-1662
Mailing Address - Street 1:1151 BADEN AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:GROVER BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93433-2703
Mailing Address - Country:US
Mailing Address - Phone:760-505-1662
Mailing Address - Fax:
Practice Address - Street 1:519 S BROADWAY
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5176
Practice Address - Country:US
Practice Address - Phone:805-925-4569
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-23
Last Update Date:2021-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty