Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2301010700 | MI |
N | 111NN0400X | Neurology | 2301010700 | MI |
NPI | 1861972309 |
---|---|
Provider Name | Dominic Fetterly |
First Address | Battle Creek, MI 49014-5440 |
Second Address | Battle Creek, MI 49014-5440 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2018 |
Last Update Date | 11/12/2018 |