Provider Demographics
NPI:1295143014
Name:FOELL CHIROPRACTIC CLINIC PA
Entity type:Organization
Organization Name:FOELL CHIROPRACTIC CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:FOELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-845-3132
Mailing Address - Street 1:201 CENTRAL AVE S
Mailing Address - Street 2:
Mailing Address - City:VALLEY CITY
Mailing Address - State:ND
Mailing Address - Zip Code:58072-3330
Mailing Address - Country:US
Mailing Address - Phone:701-845-3132
Mailing Address - Fax:701-490-3398
Practice Address - Street 1:201 CENTRAL AVE S
Practice Address - Street 2:
Practice Address - City:VALLEY CITY
Practice Address - State:ND
Practice Address - Zip Code:58072-3330
Practice Address - Country:US
Practice Address - Phone:701-845-3132
Practice Address - Fax:701-490-3398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-24
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND6004111N00000X
ND410111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND004302OtherBLUE CROSS/BLUE SHIELD
ND1464168Medicaid
ND004302OtherBLUE CROSS/BLUE SHIELD
NDN4302Medicare PIN
450366385 000OtherND WORKFORCE SAFELY