Provider Demographics
NPI:1215308465
Name:FERIANCEK, MATTHEW (DC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:FERIANCEK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 PLYMOUTH BLVD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-1381
Mailing Address - Country:US
Mailing Address - Phone:763-475-8281
Mailing Address - Fax:763-475-8291
Practice Address - Street 1:3515 PLYMOUTH BLVD
Practice Address - Street 2:#206
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-1381
Practice Address - Country:US
Practice Address - Phone:763-475-8281
Practice Address - Fax:763-475-8291
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6105111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor