MEDICARE: MARSHALL K. FELLER 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	2213	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	04452FE-31794FE	OTHER	MN	BLUE CROSS/ BLUE SHIELD

General Provider Information

NPI Number	:	1851487102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARSHALL K. FELLER D.C.

Provider Business Mailing Address
First Line	:	11680 OAKVIEW CT
Second Line	:
City	:	CHAMPLIN
State	:	MN
Zip	:	55316-2624
Country	:	US
Telephone Number	:	763-427-5315
Fax Number	:

Provider Business Practice Location Address
First Line	:	1404 85TH AVE N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55444-1416
Country	:	US
Telephone Number	:	763-561-6020
Fax Number	:

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	07/08/2007

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