Healthcare Provider Details

I. General information

NPI: 1104191618
Provider Name (Legal Business Name): MATTHEW C REPPERT D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2012
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 E EMMAUS AVE
ALLENTOWN PA
18103-4422
US

IV. Provider business mailing address

1850 E EMMAUS AVE
ALLENTOWN PA
18103-4422
US

V. Phone/Fax

Practice location:
  • Phone: 610-791-0120
  • Fax:
Mailing address:
  • Phone: 610-791-0120
  • Fax: 610-791-9691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC010577
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: