MEDICARE: MR. MATTHEW RYAN WURGLER DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	866	ND

General Provider Information

NPI Number	:	1235444019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MATTHEW RYAN WURGLER DC

Provider Business Mailing Address
First Line	:	4141 31ST AVE S
Second Line	:	SUITE 102
City	:	FARGO
State	:	ND
Zip	:	58104-8778
Country	:	US
Telephone Number	:	701-451-9098
Fax Number	:	701-451-9099

Provider Business Practice Location Address
First Line	:	4141 31ST AVE S
Second Line	:	SUITE 102
City	:	FARGO
State	:	ND
Zip	:	58104-8778
Country	:	US
Telephone Number	:	701-451-9098
Fax Number	:	701-451-9099

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2010
Last Update Date	:	08/17/2010

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