MEDICARE: JOSHUA CLARENCE FEDDES 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	JF009147	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	950E018280	OTHER	MI	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700966173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA CLARENCE FEDDES DC

Provider Business Mailing Address
First Line	:	5600 METROPOLITAN PKWY
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-4107
Country	:	US
Telephone Number	:	586-264-2100
Fax Number	:	586-264-1117

Provider Business Practice Location Address
First Line	:	5600 METROPOLITAN PKWY
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-4107
Country	:	US
Telephone Number	:	586-264-2100
Fax Number	:	586-264-1117

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	07/09/2007

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Directions to “ JOSHUA CLARENCE FEDDES DC” Practice Location

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