Provider Demographics
NPI:1336239292
Name:FENN, JOHN ALLEN (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALLEN
Last Name:FENN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:800 BATTLEFIELD BLVD S STE 111
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-6670
Mailing Address - Country:US
Mailing Address - Phone:757-482-8445
Mailing Address - Fax:757-482-9265
Practice Address - Street 1:800 BATTLEFIELD BLVD S STE 111
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-6670
Practice Address - Country:US
Practice Address - Phone:757-482-8445
Practice Address - Fax:757-482-9265
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001678111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU61079Medicare UPIN