Healthcare Provider Details

I. General information

NPI: 1295793925
Provider Name (Legal Business Name): MATTHEW DAVID DIPIAZZA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 N MAIN ST
CAMBRIDGE WI
53523-9221
US

IV. Provider business mailing address

5938 FOREST LN
FITCHBURG WI
53711-5170
US

V. Phone/Fax

Practice location:
  • Phone: 608-423-4666
  • Fax:
Mailing address:
  • Phone: 608-423-4666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3783-012
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: