Provider Demographics
NPI:1972708089
Name:FOELL PC
Entity type:Organization
Organization Name:FOELL PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:FOELL
Authorized Official - Suffix:
Authorized Official - Credentials:DOC
Authorized Official - Phone:605-432-6418
Mailing Address - Street 1:304 E 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:MILBANK
Mailing Address - State:SD
Mailing Address - Zip Code:57252-2545
Mailing Address - Country:US
Mailing Address - Phone:605-432-6418
Mailing Address - Fax:605-432-6418
Practice Address - Street 1:304 E 4TH AVE
Practice Address - Street 2:
Practice Address - City:MILBANK
Practice Address - State:SD
Practice Address - Zip Code:57252-2545
Practice Address - Country:US
Practice Address - Phone:605-432-6418
Practice Address - Fax:605-432-6418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1018111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7601790Medicaid
MN5841101Medicaid
SDS41768Medicare PIN
MN5841101Medicaid