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General NPI Number Information
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NPI Number | 1285890640
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Entity Type | Individual
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Provider Name | RYAN THOMAS FUELLEMAN B.S. D.C.
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Gender | Male
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Dates
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Enumeration Date | 08/04/2008
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Last Update Date | 05/28/2014
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Provider Practice Location Address
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Address Line | 1831 W COURT ST
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City | JANESVILLE
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State | WI
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Zip | 53548-3406
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Country | US
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Telephone | 608-312-7825
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Fax |
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Provider Business Mailing Address
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Address Line | 4353 W SPRING CREEK RD
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City | BELOIT
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State | WI
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Zip | 53511-8487
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Country | US
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Telephone | 608-312-7825
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 4663-012
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License Number State | WI
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