Healthcare Provider Details

I. General information

NPI: 1972708089
Provider Name (Legal Business Name): FOELL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 E 4TH AVE
MILBANK SD
57252-2545
US

IV. Provider business mailing address

304 E 4TH AVE
MILBANK SD
57252-2545
US

V. Phone/Fax

Practice location:
  • Phone: 605-432-6418
  • Fax: 605-432-6418
Mailing address:
  • Phone: 605-432-6418
  • Fax: 605-432-6418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1018
License Number StateSD

VIII. Authorized Official

Name: DR. MATTHEW RYAN FOELL
Title or Position: CHIROPRACTER
Credential: DOC
Phone: 605-432-6418