Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 01-05-163 | KS |
N | 111NI0013X | Independent Medical Examiner | 01-05-163 | KS |
NPI | 1023292604 |
---|---|
Provider Name | Dr. Jeffrey Fenn |
First Address | Wichita, KS 67208-1844 |
Second Address | Wichita, KS 67208-1844 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2007 |
Last Update Date | 02/05/2008 |