Healthcare Provider Details

I. General information

NPI: 1841244233
Provider Name (Legal Business Name): CAMBRIDGE CLINIC OF CHIROPRACTIC, L.C.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 08/22/2020
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

416 N MAIN ST
CAMBRIDGE WI
53523-9221
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: DR. MATTHEW DAVID DIPIAZZA
Title or Position: DOCTOR OF CHIROPRACTIC
Credential: D.C.
Phone: 608-423-4666