MEDICARE: DAVID R FELTON

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	DF002160	MI
2	111N00000X	Chiropractor	2301009250	MI

General Provider Information

NPI Number	:	1447377171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID R FELTON

Provider Business Mailing Address
First Line	:	4110 LAKE MICHIGAN DR NW
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49534-4527
Country	:	US
Telephone Number	:	616-453-3404
Fax Number	:	616-453-3418

Provider Business Practice Location Address
First Line	:	4110 LAKE MICHIGAN DR NW
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49534-4527
Country	:	US
Telephone Number	:	616-453-3404
Fax Number	:	616-453-3418

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. DAVID ROBERT FELTON
Credential	:	DC
Telephone Number	:	616-453-3404

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	08/22/2020

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