Doctor Name: | STEPHEN MATTHEW FENTON |
NPI Number: | 1427379528 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DC |
License Number: | 038-011703 |
Business Practice Address: | 490 W Side Sq Carlinville, IL - 626261796 |
Business Phone Number: | 2178542557 |
Business Fax Number: | |
Mailing Address: | 19244 Hurricane Dr, CARLINVILLE |
State: | IL |
Postal Code: | 626269380 |
Phone Number: | 2175564865 |
Fax Number: | |
NPI Enumeration Date: | 06/13/2010 |
NPI Last Update Date: | 06/13/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 111N00000X |
License Number: | 038-011703 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Chiropractic Providers |
Taxonomy Classification: | Chiropractor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |