Healthcare Provider Details

I. General information

NPI: 1023292604
Provider Name (Legal Business Name): JEFFREY FENN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2007
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6224 SHADYBROOK ST
WICHITA KS
67208-1844
US

IV. Provider business mailing address

6224 SHADYBROOK ST
WICHITA KS
67208-1844
US

V. Phone/Fax

Practice location:
  • Phone: 316-683-9500
  • Fax: 316-683-9502
Mailing address:
  • Phone: 316-683-9500
  • Fax: 316-683-9502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number01-05-163
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number01-05-163
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: