MEDICARE: FIEDLER CHIROPRACTIC INC

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

General Provider Information

NPI Number	:	1083773642
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIEDLER CHIROPRACTIC INC

Provider Business Mailing Address
First Line	:	PO BOX 298
Second Line	:
City	:	LOWER LAKE
State	:	CA
Zip	:	95457
Country	:	US
Telephone Number	:	707-994-6940
Fax Number	:	707-994-6941

Provider Business Practice Location Address
First Line	:	9667 HWY 29
Second Line	:	STE 101
City	:	LOWER LAKE
State	:	CA
Zip	:	95457
Country	:	US
Telephone Number	:	707-994-6940
Fax Number	:	707-994-6941

Authorized Official
Title or Position	:	OFC MGR
Name	:	MRS. CYNTHIA E SHORE
Credential	:
Telephone Number	:	707-994-6940

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	08/22/2020

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