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General NPI Number Information
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NPI Number | 1144326356
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Entity Type | Organization
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Legal Business Name | FEDORKO CHIROPRACTIC HEALTH CTR
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4774 MUNSON ST NW SUITE 302
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City | CANTON
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State | OH
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Zip | 44718-3634
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Country | US
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Telephone | 330-494-0422
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Fax | 330-494-3601
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Provider Business Mailing Address
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Address Line | 4774 MUNSON ST NW SUITE 302
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City | CANTON
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State | OH
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Zip | 44718-3634
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Country | US
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Telephone | 330-494-0422
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Fax | 330-494-3601
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Authorized Official
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Title or Position | CHIROPRACTOR OWNER
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Name | DR. JEFFREY STEVEN FEDORKO
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Credential | DC
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Telephone | 330-494-0422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 919
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License Number State | OH
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