Healthcare Provider Details

I. General information

NPI: 1629137369
Provider Name (Legal Business Name): MATTHEW BRIAN HORVATH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 N WINSTEAD AVE
ROCKY MOUNT NC
27804-2235
US

IV. Provider business mailing address

112 N WINSTEAD AVE
ROCKY MOUNT NC
27804-2235
US

V. Phone/Fax

Practice location:
  • Phone: 252-443-7496
  • Fax: 252-443-9062
Mailing address:
  • Phone: 252-443-7496
  • Fax: 252-443-9062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number1935
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number1182
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number006532
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: