Provider Demographics
NPI:1912098757
Name:FELDKAMP, PETER DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:DAVID
Last Name:FELDKAMP
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 1:4227 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
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1446111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0817512Medicaid
000000120863OtherANTHEM
U01808Medicare UPIN
PI9299981Medicare ID - Type Unspecified