Healthcare Provider Details

I. General information

NPI: 1558520585
Provider Name (Legal Business Name): MATHESIE CHIROPRACTIC LIFE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10617 W ATLANTIC BLVD
CORAL SPRINGS FL
33071-5610
US

IV. Provider business mailing address

10617 W ATLANTIC BLVD
CORAL SPRINGS FL
33071-5610
US

V. Phone/Fax

Practice location:
  • Phone: 954-755-1434
  • Fax:
Mailing address:
  • Phone: 954-755-1434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL W MATHESIE
Title or Position: BOD
Credential: D.C.
Phone: 954-755-1434