Provider Demographics
NPI:1831378520
Name:FELDKAMP CHIROPRACTIC CLINIC INC
Entity type:Organization
Organization Name:FELDKAMP CHIROPRACTIC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:FELDKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:614-875-3338
Mailing Address - Street 1:4227 HOOVER RD
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-3617
Mailing Address - Country:US
Mailing Address - Phone:614-875-3338
Mailing Address - Fax:614-875-3034
Practice Address - Street 1:4227 HOOVER RD
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-3617
Practice Address - Country:US
Practice Address - Phone:614-875-3338
Practice Address - Fax:614-875-3034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1446111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0817512Medicaid
OH0817512Medicaid