MEDICARE: JORDAN ALEXANDRA 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-5086	MT

General Provider Information

NPI Number	:	1831675875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN ALEXANDRA FENNELLY DC

Provider Business Mailing Address
First Line	:	559 EDGEWOOD PL
Second Line	:
City	:	WHITEFISH
State	:	MT
Zip	:	59937-2358
Country	:	US
Telephone Number	:	406-249-6312
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	:	406-730-8569
Fax Number	:

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

Provider Enumeration Date	:	07/12/2018
Last Update Date	:	03/31/2026

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