Healthcare Provider Details

I. General information

NPI: 1366618084
Provider Name (Legal Business Name): FENN CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2008
Last Update Date: 06/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2548 N MAIZE CT STE 104
WICHITA KS
67205-7348
US

IV. Provider business mailing address

2548 N MAIZE CT STE 104
WICHITA KS
67205-7348
US

V. Phone/Fax

Practice location:
  • Phone: 316-722-4247
  • Fax: 316-722-4287
Mailing address:
  • Phone: 316-722-4247
  • Fax: 316-722-4287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number44143
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number0422530
License Number StateKS

VIII. Authorized Official

Name: DR. JEFFREY D FENN
Title or Position: CEO
Credential: D.C.
Phone: 316-722-4247