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General NPI Number Information
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NPI Number | 1356447213
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Entity Type | Organization
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Legal Business Name | MATTSON FAMILY CHIROPRACTIC PC
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 01/28/2013
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Provider Practice Location Address
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Address Line | 520 E AYER ST
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City | IRONWOOD
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State | MI
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Zip | 49938-2204
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Country | US
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Telephone | 906-932-4605
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Fax | 906-932-4875
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Provider Business Mailing Address
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Address Line | 520 E AYER ST
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City | IRONWOOD
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State | MI
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Zip | 49938-2204
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Country | US
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Telephone | 906-932-4605
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Fax | 906-932-4875
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. DORIAN L MATTSON
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Credential | DC
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Telephone | 906-932-4605
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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 | 2301007489
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License Number State | MI
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