Provider Demographics
NPI:1447377171
Name:DAVID R FELTON
Entity type:Organization
Organization Name:DAVID R FELTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:FELTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-453-3404
Mailing Address - Street 1:4110 LAKE MICHIGAN DR NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49534-4527
Mailing Address - Country:US
Mailing Address - Phone:616-453-3404
Mailing Address - Fax:616-453-3418
Practice Address - Street 1:4110 LAKE MICHIGAN DR NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49534-4527
Practice Address - Country:US
Practice Address - Phone:616-453-3404
Practice Address - Fax:616-453-3418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009250111N00000X
MIDF002160111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIT32894Medicare UPIN
MIOD150150Medicare ID - Type Unspecified