Healthcare Provider Details

I. General information

NPI: 1669458006
Provider Name (Legal Business Name): WILLIAM ALBIN MATIJASIC DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 LIBERTY AVE
VERMILION OH
44089-1912
US

IV. Provider business mailing address

4500 LIBERTY AVE
VERMILION OH
44089-1912
US

V. Phone/Fax

Practice location:
  • Phone: 440-967-8077
  • Fax: 440-967-0591
Mailing address:
  • Phone: 440-967-8077
  • Fax: 440-967-0591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number789
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: