Healthcare Provider Details

I. General information

NPI: 1851383285
Provider Name (Legal Business Name): RICHARD MATTHEWS DC DACNB
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 VIRGINIA AVE #45
FORT PIERCE FL
34982-5893
US

IV. Provider business mailing address

800 VIRGINIA AVE #45
FORT PIERCE FL
34982-5893
US

V. Phone/Fax

Practice location:
  • Phone: 772-466-9575
  • Fax: 772-466-9475
Mailing address:
  • Phone: 772-466-9575
  • Fax: 772-466-9475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License NumberCH13817
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: