Provider Demographics
NPI:1154382554
Name:FELAHY, WALID STEPHAN (DC)
Entity type:Individual
Prefix:DR
First Name:WALID
Middle Name:STEPHAN
Last Name:FELAHY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:WALLY
Other - Middle Name:STEPHAN
Other - Last Name:FELAHY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1310 E SWAIN RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-3378
Mailing Address - Country:US
Mailing Address - Phone:209-952-0126
Mailing Address - Fax:209-952-2403
Practice Address - Street 1:1310 E SWAIN RD
Practice Address - Street 2:SUITE 1
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-3378
Practice Address - Country:US
Practice Address - Phone:209-952-0126
Practice Address - Fax:209-952-2403
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30001111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor