Provider Demographics
NPI:1528735206
Name:FELDT, LOGAN MARSHALL (DC)
Entity type:Individual
Prefix:DR
First Name:LOGAN
Middle Name:MARSHALL
Last Name:FELDT
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 1:113 E PRICE ST UNIT 301
Mailing Address - Street 2:
Mailing Address - City:ELDRIDGE
Mailing Address - State:IA
Mailing Address - Zip Code:52748-1779
Mailing Address - Country:US
Mailing Address - Phone:715-321-1157
Mailing Address - Fax:
Practice Address - Street 1:1441 BELLEVUE ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-5605
Practice Address - Country:US
Practice Address - Phone:920-468-1963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5679-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor