Provider Demographics
NPI:1316931587
Name:FELLERMAN, DAVID ERIC (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ERIC
Last Name:FELLERMAN
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 1:183 MARKET ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5444
Mailing Address - Country:US
Mailing Address - Phone:570-718-6565
Mailing Address - Fax:570-714-8750
Practice Address - Street 1:183 MARKET ST
Practice Address - Street 2:SUITE 201
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5444
Practice Address - Country:US
Practice Address - Phone:570-718-6565
Practice Address - Fax:570-714-8750
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-02
Last Update Date:2007-07-09
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
PADC-006797-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA0162237Medicaid
PAMA0162237Medicaid
PAU62142Medicare UPIN