Healthcare Provider Details

I. General information

NPI: 1194864199
Provider Name (Legal Business Name): JAMES FENTON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 1ST STREET SOUTH
REFORM AL
35481-0340
US

IV. Provider business mailing address

PO BOX 340
REFORM AL
35481-0340
US

V. Phone/Fax

Practice location:
  • Phone: 205-375-2959
  • Fax: 205-375-9021
Mailing address:
  • Phone: 205-375-2959
  • Fax: 205-375-9021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1562
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: