MEDICARE: VIVIAN BARBOUR FEDEROWICZ DC

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	111NP0017X	Pediatric Chiropractor	4788	NC

General Provider Information

NPI Number	:	1134684467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIVIAN BARBOUR FEDEROWICZ DC

Provider Business Mailing Address
First Line	:	9116 DEERSHIRE CT
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27615-4099
Country	:	US
Telephone Number	:	919-820-2201
Fax Number	:

Provider Business Practice Location Address
First Line	:	7530 RAMBLE WAY
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27616-4315
Country	:	US
Telephone Number	:	919-790-8054
Fax Number	:

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

Provider Enumeration Date	:	01/31/2019
Last Update Date	:	01/31/2019

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