Healthcare Provider Details

I. General information

NPI: 1932473899
Provider Name (Legal Business Name): MATTHYS FAMILY & SPORTS CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2012
Last Update Date: 02/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3475 JERSEY RIDGE RD
DAVENPORT IA
52807-2293
US

IV. Provider business mailing address

3475 JERSEY RIDGE RD
DAVENPORT IA
52807-2293
US

V. Phone/Fax

Practice location:
  • Phone: 563-359-4779
  • Fax: 563-359-4965
Mailing address:
  • Phone: 563-359-4779
  • Fax: 563-359-4965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number007409
License Number StateIA

VIII. Authorized Official

Name: DR. TIMOTHY MICHAEL MATTHYS
Title or Position: OWNER/CHIROPRACTOR
Credential: D.C.
Phone: 563-359-4779