Provider Demographics
NPI:1548627813
Name:KREUL, MATTHEW RYAN (DC)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:RYAN
Last Name:KREUL
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 1:924 GOBLIN DR
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-8885
Mailing Address - Country:US
Mailing Address - Phone:870-743-3311
Mailing Address - Fax:870-743-3323
Practice Address - Street 1:924 GOBLIN DR
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-8885
Practice Address - Country:US
Practice Address - Phone:870-743-3311
Practice Address - Fax:870-743-3323
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-18
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016000847111N00000X
AR16134111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor