Provider Demographics
NPI:1427130939
Name:FECHT, GREG V (DC)
Entity type:Individual
Prefix:DR
First Name:GREG
Middle Name:V
Last Name:FECHT
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 1:4519 ADMIRALTY WAY STE C
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5455
Mailing Address - Country:US
Mailing Address - Phone:310-486-5123
Mailing Address - Fax:
Practice Address - Street 1:4519 ADMIRALTY WAY STE C
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5455
Practice Address - Country:US
Practice Address - Phone:310-574-3334
Practice Address - Fax:310-574-3336
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26281111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU94103Medicare UPIN