Provider Demographics
NPI:1851487102
Name:FELLER, MARSHALL K (DC)
Entity Type:Individual
Prefix:
First Name:MARSHALL
Middle Name:K
Last Name:FELLER
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 1:11680 OAKVIEW CT
Mailing Address - Street 2:
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-2624
Mailing Address - Country:US
Mailing Address - Phone:763-427-5315
Mailing Address - Fax:
Practice Address - Street 1:1404 85TH AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55444-1416
Practice Address - Country:US
Practice Address - Phone:763-561-6020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2213111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN04452FE-31794FEOtherBLUE CROSS/ BLUE SHIELD