Provider Demographics
NPI:1952340309
Name:FEELEY, JONATHAN MATTHEW (DC)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:MATTHEW
Last Name:FEELEY
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 1:2318 HATHAWAY RD
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:KY
Mailing Address - Zip Code:41091-9703
Mailing Address - Country:US
Mailing Address - Phone:859-384-4396
Mailing Address - Fax:
Practice Address - Street 1:3982 TURKEYFOOT RD
Practice Address - Street 2:
Practice Address - City:ERLANGER
Practice Address - State:KY
Practice Address - Zip Code:41018-2840
Practice Address - Country:US
Practice Address - Phone:859-363-3756
Practice Address - Fax:859-331-6000
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4962111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U95157Medicare UPIN
6106901Medicare ID - Type Unspecified