MEDICARE: DR. KENNETH S FEDER 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	111N00000X	Chiropractor	CH2523	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164424297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH S FEDER DC

Provider Business Mailing Address
First Line	:	2310 TAMIAMI TRL
Second Line	:	SUITE 2121
City	:	PUNTA GORDA
State	:	FL
Zip	:	33950-5932
Country	:	US
Telephone Number	:	941-205-2225
Fax Number	:	941-205-3000

Provider Business Practice Location Address
First Line	:	2310 TAMIAMI TRL
Second Line	:	SUITE 2121
City	:	PUNTA GORDA
State	:	FL
Zip	:	33950-5932
Country	:	US
Telephone Number	:	941-205-2225
Fax Number	:	941-205-3000

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	10/08/2010

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Directions to “ DR. KENNETH S FEDER DC” Practice Location

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