Provider Demographics
NPI:1063595627
Name:FELDEWERTH, FRED DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:DAVID
Last Name:FELDEWERTH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 CHICKADEE CT
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-4541
Mailing Address - Country:US
Mailing Address - Phone:636-332-2097
Mailing Address - Fax:
Practice Address - Street 1:202 S MAIN ST
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-2805
Practice Address - Country:US
Practice Address - Phone:636-978-7700
Practice Address - Fax:636-978-7700
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006459111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor