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General NPI Number Information
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NPI Number | 1154698298
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Entity Type | Organization
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Legal Business Name | MICHAEL MATUSZCZAK DC, PA
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Dates
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Enumeration Date | 11/17/2011
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Last Update Date | 11/17/2011
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Provider Practice Location Address
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Address Line | 3 FLORIDA PARK DR N
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City | PALM COAST
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State | FL
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Zip | 32137-8189
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Country | US
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Telephone | 386-445-4455
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Fax | 386-445-4110
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Provider Business Mailing Address
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Address Line | 3 FLORIDA PARK DR N
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City | PALM COAST
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State | FL
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Zip | 32137-8189
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Country | US
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Telephone | 386-445-4455
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Fax | 386-445-4110
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Authorized Official
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Title or Position | MEMBER
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Name | MICHAEL MATUSZCZAK
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Credential | DC
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Telephone | 386-445-4455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH 4620
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License Number State | FL
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