MEDICARE: MATT SHIELDS DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH14061	FL

General Provider Information

NPI Number	:	1619682184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATT SHIELDS DC

Provider Business Mailing Address
First Line	:	1534 PLAINFIELD AVE
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-3925
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1534 PLAINFIELD AVE
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-3925
Country	:	US
Telephone Number	:	989-598-1912
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2023
Last Update Date	:	01/19/2023

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Directions to “ MATT SHIELDS DC” Practice Location

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