MEDICARE: DR. JOEL STEPHEN LOGELIN 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	1672-012	WI
2	111N00000X	Chiropractor	653	WY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780613968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOEL STEPHEN LOGELIN DC

Provider Business Mailing Address
First Line	:	1605 7 1/2 AVENUE
Second Line	:
City	:	DALLAS
State	:	WI
Zip	:	54733-9457
Country	:	US
Telephone Number	:	715-837-1622
Fax Number	:	715-837-1622

Provider Business Practice Location Address
First Line	:	1605 7 1/2 AVENUE
Second Line	:
City	:	DALLAS
State	:	WI
Zip	:	54733-9457
Country	:	US
Telephone Number	:	715-837-1622
Fax Number	:	715-837-1622

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

Provider Enumeration Date	:	07/01/2006
Last Update Date	:	10/08/2010

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