Healthcare Provider Details

I. General information

NPI: 1962697706
Provider Name (Legal Business Name): MATTHEW DORCHESTER, DC, CCSP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2007
Last Update Date: 01/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18325 N ALLIED WAY SUITE 105
PHOENIX AZ
85054-3105
US

IV. Provider business mailing address

8894 E RUSTY SPUR PL
SCOTTSDALE AZ
85255-9166
US

V. Phone/Fax

Practice location:
  • Phone: 480-991-3399
  • Fax: 480-905-0815
Mailing address:
  • Phone: 480-991-3399
  • Fax: 480-905-0815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number1578
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number10597
License Number StateAZ

VIII. Authorized Official

Name: MATTHEW DORCHESTER
Title or Position: PHYSICIAN
Credential: DC
Phone: 480-991-3399