Healthcare Provider Details

I. General information

NPI: 1457510497
Provider Name (Legal Business Name): MICHAEL W. MATHESIE, D.C.,P.A.
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:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL MATHESIE
Title or Position: BOD
Credential:
Phone: 954-755-1434