MEDICARE: DR. PATRICK LOUIS FENELUS D.C.

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	CH8094	FL

General Provider Information

NPI Number	:	1003836826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICK LOUIS FENELUS D.C.

Provider Business Mailing Address
First Line	:	4121 NW 5TH ST
Second Line	:	STE 215
City	:	PLANTATION
State	:	FL
Zip	:	33317-2120
Country	:	US
Telephone Number	:	954-358-0301
Fax Number	:	954-316-4547

Provider Business Practice Location Address
First Line	:	4121 NW 5TH ST
Second Line	:	STE 215
City	:	PLANTATION
State	:	FL
Zip	:	33317-2120
Country	:	US
Telephone Number	:	954-358-0301
Fax Number	:	954-316-4547

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	07/08/2007

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