Provider Demographics
NPI:1013674308
Name:TOELLE, MACY
Entity Type:Individual
Prefix:
First Name:MACY
Middle Name:
Last Name:TOELLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 E 8TH AVE APT 308
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-2160
Mailing Address - Country:US
Mailing Address - Phone:320-305-2844
Mailing Address - Fax:
Practice Address - Street 1:310 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PARKSTON
Practice Address - State:SD
Practice Address - Zip Code:57366-2014
Practice Address - Country:US
Practice Address - Phone:605-928-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-21
Last Update Date:2021-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1427111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty