Active NPI
Roger Lee Fenneman, L.AC.
- Acupuncturist
- Cottonwood, AZ
National Provider Identifier
1649441445
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- 0555
- Practice address
- 687 N Main St Unit a
Cottonwood, AZ 86326-3201 - Phone
- (928) 852-7275
- Fax
- (928) 852-7275
- NPI assigned
- Mar 19, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist | 171100000X | 555 | AZ | |
| Acupuncturist | 171100000X | 0555 | AZ | Primary |
Addresses
Primary practice location
687 N Main St Unit a
Cottonwood, AZ 86326-3201
Mailing address
687 N Main St Unit a
Cottonwood, AZ 86326-3201
Phone (928) 852-7275
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0555 | AZ | MD | Acupuncturist |
| 555 | AZ | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1205884800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1675728000000",
"number": "1649441445",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "687 N MAIN ST UNIT A",
"city": "COTTONWOOD",
"state": "AZ",
"postal_code": "863263201",
"telephone_number": "928-852-7275",
"fax_number": "928-852-7275"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "687 N MAIN ST UNIT A",
"city": "COTTONWOOD",
"state": "AZ",
"postal_code": "863263201",
"telephone_number": "928-852-7275",
"fax_number": "928-852-7275"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FENNEMAN",
"first_name": "ROGER",
"middle_name": "LEE",
"name_prefix": "Mr.",
"credential": "L.AC.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-03-19",
"last_updated": "2023-02-07",
"certification_date": "2023-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "AZ",
"license": "555",
"primary": false
},
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "AZ",
"license": "0555",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cottonwood, AZ
- Farshid Paydar, M.D., P.C. (The Eye Clinic)
- Farshid Paydar, M.D.,P.C. (The Eye Clinic)
- S Blair Faulkner, M.D.
- Tyler Mathew Faust, DC
- Howard Stephen Feldman, M.D.
- Kathy Lynn Fisher, O.M.D.,ACUPUNCTURIST
- Timothy J Fitch, PA-C
- Forefront Dermatology SC (Arizona Dermatology Group, a Forefront Dermatology Practice)
- Fornara Eye Center P.C.
- Jason Wesley Fornara, O.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.