MEDICARE: FECF, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	12705	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174049159
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FECF, LLC

Provider Business Mailing Address
First Line	:	100 W TEXAS AVE
Second Line	:	416
City	:	WEBSTER
State	:	TX
Zip	:	77598-3280
Country	:	US
Telephone Number	:	518-542-9371
Fax Number	:

Provider Business Practice Location Address
First Line	:	15502 GALVESTON ROAD
Second Line	:	#207
City	:	HOUSTON
State	:	TX
Zip	:	77598-7759
Country	:	US
Telephone Number	:	281-607-3043
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. KATHERINE VAN WAGENEN
Credential	:	DC
Telephone Number	:	518-542-9371

Provider Enumeration Date	:	08/21/2017
Last Update Date	:	08/21/2017

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Directions to “FECF, LLC ” Practice Location

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