Healthcare Provider Details

I. General information

NPI: 1356646533
Provider Name (Legal Business Name): MATTHEW CLAY FREUDENTHAL D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2011
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7514 42ND AVE N
NEW HOPE MN
55427-1225
US

IV. Provider business mailing address

7514 42ND AVE N
NEW HOPE MN
55427-1225
US

V. Phone/Fax

Practice location:
  • Phone: 763-746-1244
  • Fax: 763-746-1246
Mailing address:
  • Phone: 763-746-1244
  • Fax: 763-746-1246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5452
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: