MEDICARE: DR. MATTHEW RYAN KREUL D.C.

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	2016000847	MO
2	111N00000X	Chiropractor	16134	AR

General Provider Information

NPI Number	:	1548627813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW RYAN KREUL D.C.

Provider Business Mailing Address
First Line	:	924 GOBLIN DR
Second Line	:
City	:	HARRISON
State	:	AR
Zip	:	72601-8885
Country	:	US
Telephone Number	:	870-743-3311
Fax Number	:	870-743-3323

Provider Business Practice Location Address
First Line	:	924 GOBLIN DR
Second Line	:
City	:	HARRISON
State	:	AR
Zip	:	72601-8885
Country	:	US
Telephone Number	:	870-743-3311
Fax Number	:	870-743-3323

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

Provider Enumeration Date	:	01/18/2016
Last Update Date	:	07/21/2016

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