Healthcare Provider Details

I. General information

NPI: 1558142042
Provider Name (Legal Business Name): MATTHEW STEPHEN BOOTH DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2023
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 E BROAD ST
SOUDERTON PA
18964-1220
US

IV. Provider business mailing address

655 E BROAD ST
SOUDERTON PA
18964-1220
US

V. Phone/Fax

Practice location:
  • Phone: 215-703-9999
  • Fax: 215-703-9897
Mailing address:
  • Phone: 215-703-9999
  • Fax: 215-703-9897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC011933
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: