Healthcare Provider Details

I. General information

NPI: 1871110635
Provider Name (Legal Business Name): MATTHEW SHEM DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2020
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4740 FLINTRIDGE DR STE 220
COLORADO SPRINGS CO
80918-4273
US

IV. Provider business mailing address

4740 FLINTRIDGE DR STE 220
COLORADO SPRINGS CO
80918-4273
US

V. Phone/Fax

Practice location:
  • Phone: 719-208-4314
  • Fax: 719-960-2192
Mailing address:
  • Phone: 719-208-4314
  • Fax: 719-960-2192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number6479
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: