Provider Demographics
NPI:1538441126
Name:FENNELLY, ALEX LEIGH (DC)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:LEIGH
Last Name:FENNELLY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:ALEX
Other - Middle Name:LEIGH
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:450 CORPORATE DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-6094
Mailing Address - Country:US
Mailing Address - Phone:406-755-3014
Mailing Address - Fax:406-205-2586
Practice Address - Street 1:450 CORPORATE DR
Practice Address - Street 2:SUITE 108
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-6094
Practice Address - Country:US
Practice Address - Phone:406-755-3014
Practice Address - Fax:406-205-2586
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1257111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor