Healthcare Provider Details

I. General information

NPI: 1295833424
Provider Name (Legal Business Name): WILLIAM CECIL METTLER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 05/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S BROADWAY ST
SPRING VALLEY MN
55975-1227
US

IV. Provider business mailing address

105 S BROADWAY ST
SPRING VALLEY MN
55975-1227
US

V. Phone/Fax

Practice location:
  • Phone: 507-346-1077
  • Fax: 507-346-7117
Mailing address:
  • Phone: 507-346-1077
  • Fax: 507-346-7117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3063
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: