Healthcare Provider Details

I. General information

NPI: 1740803170
Provider Name (Legal Business Name): MATTHEW KUO DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2020
Last Update Date: 05/20/2020
Certification Date: 05/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 GEZON PKWY SW
WYOMING MI
49509-9542
US

IV. Provider business mailing address

1027 GEZON PKWY SW
WYOMING MI
49509-9542
US

V. Phone/Fax

Practice location:
  • Phone: 616-301-8300
  • Fax:
Mailing address:
  • Phone: 616-301-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301010934
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: