MEDICARE: PETER FENNELLY 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	CHI-CHI-LIC-6130	MT

General Provider Information

NPI Number	:	1710525613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER FENNELLY DC

Provider Business Mailing Address
First Line	:	559 EDGEWOOD PL
Second Line	:
City	:	WHITEFISH
State	:	MT
Zip	:	59937-2358
Country	:	US
Telephone Number	:	406-471-2498
Fax Number	:

Provider Business Practice Location Address
First Line	:	559 EDGEWOOD PL
Second Line	:
City	:	WHITEFISH
State	:	MT
Zip	:	59937-2358
Country	:	US
Telephone Number	:	406-471-2498
Fax Number	:

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

Provider Enumeration Date	:	12/11/2019
Last Update Date	:	12/11/2019

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Directions to “ PETER FENNELLY DC” Practice Location

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