Provider Demographics
NPI:1477646966
Name:FUELLING, MATTHEW PATRICK (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:PATRICK
Last Name:FUELLING
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 1:231 2ND AVE N.E.
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:IA
Mailing Address - Zip Code:50644
Mailing Address - Country:US
Mailing Address - Phone:319-334-3214
Mailing Address - Fax:319-334-2613
Practice Address - Street 1:231 2ND AVE N.E.
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:IA
Practice Address - Zip Code:50644
Practice Address - Country:US
Practice Address - Phone:319-334-3214
Practice Address - Fax:319-334-2613
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06269111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1206482Medicaid
IA1206482Medicaid