Provider Demographics
NPI:1598733446
Name:FOELL, MATTHEW RYAN II (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:RYAN
Last Name:FOELL
Suffix:II
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 1:304 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1018111N00000X
MN4067111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN864639200Medicaid
SD7601790Medicaid
MN864639200Medicaid
SDS41770Medicare PIN
SDU84812Medicare UPIN