MEDICARE: DR. JARED HEATH FIEDLER 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	DC010602	PA
2	111N00000X	Chiropractor	0104557100	VA

General Provider Information

NPI Number	:	1710257506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JARED HEATH FIEDLER D.C.

Provider Business Mailing Address
First Line	:	1335 FISHERMANS RD
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23503-4037
Country	:	US
Telephone Number	:	610-996-3433
Fax Number	:

Provider Business Practice Location Address
First Line	:	1920 CENTERVILLE TPKE
Second Line	:	SUITE 95
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-6800
Country	:	US
Telephone Number	:	610-996-3433
Fax Number	:

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

Provider Enumeration Date	:	01/10/2012
Last Update Date	:	03/04/2015

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