Healthcare Provider Details

I. General information

NPI: 1205922283
Provider Name (Legal Business Name): MATTHEW WORTH DC, DACNB
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 SMIZER STATION RD
VALLEY PARK MO
63088-2097
US

IV. Provider business mailing address

PO BOX 672
FENTON MO
63026-0672
US

V. Phone/Fax

Practice location:
  • Phone: 636-861-8558
  • Fax: 636-825-6176
Mailing address:
  • Phone: 636-861-8558
  • Fax: 636-825-6176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number0006485
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: