Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH8094 | FL |
NPI | 1003836826 |
---|---|
Provider Name | Dr. Patrick Louis Fenelus |
First Address | Plantation, FL 33317-2120 |
Second Address | Plantation, FL 33317-2120 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V05526 | (02) | FL |