Provider Demographics
NPI:1295833424
Name:METTLER, WILLIAM CECIL (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CECIL
Last Name:METTLER
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 1:105 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55975-1227
Mailing Address - Country:US
Mailing Address - Phone:507-346-1077
Mailing Address - Fax:507-346-7117
Practice Address - Street 1:105 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55975-1227
Practice Address - Country:US
Practice Address - Phone:507-346-1077
Practice Address - Fax:507-346-7117
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2012-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3063111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3C399MEOtherBCBS
MN029013100Medicaid
MN029013100Medicaid
MNU44714Medicare UPIN