Healthcare Provider Details

I. General information

NPI: 1205438827
Provider Name (Legal Business Name): MATTHEW B. COHEN DC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2020
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28107 JOHN R RD
MADISON HEIGHTS MI
48071-2810
US

IV. Provider business mailing address

28107 JOHN R RD
MADISON HEIGHTS MI
48071-2810
US

V. Phone/Fax

Practice location:
  • Phone: 248-542-3492
  • Fax: 248-542-3494
Mailing address:
  • Phone: 248-542-3492
  • Fax: 248-542-3494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. MATTHEW BRYAN COHEN
Title or Position: OWNER
Credential: DC
Phone: 248-542-3492