Healthcare Provider Details

I. General information

NPI: 1235334988
Provider Name (Legal Business Name): MATTHIAS H HUTZENBILER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1428 W VILLARD ST
DICKINSON ND
58601-4648
US

IV. Provider business mailing address

1428 W VILLARD ST
DICKINSON ND
58601-4648
US

V. Phone/Fax

Practice location:
  • Phone: 701-483-6917
  • Fax: 701-483-6916
Mailing address:
  • Phone: 701-483-6917
  • Fax: 701-483-6916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number792
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: