Healthcare Provider Details

I. General information

NPI: 1043448459
Provider Name (Legal Business Name): NICHOLAS DOELING
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2009
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 STATE HIGHWAY 29 S
ALEXANDRIA MN
56308-6196
US

IV. Provider business mailing address

500 CROSS ST
BIG STONE CITY SD
57216-8237
US

V. Phone/Fax

Practice location:
  • Phone: 320-763-8888
  • Fax: 320-200-7478
Mailing address:
  • Phone: 605-541-1140
  • Fax: 605-541-0109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8346
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: