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General NPI Number Information
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NPI Number | 1740684794
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Entity Type | Individual
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Provider Name | MATTHEW EVAN FLOTTERUD DC, ATC
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Gender | Male
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Dates
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Enumeration Date | 10/20/2014
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Last Update Date | 10/03/2022
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Provider Practice Location Address
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Address Line | 511 HIGHWAY 1 S
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City | WASHINGTON
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State | IA
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Zip | 52353-9782
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Country | US
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Telephone | 319-653-5494
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Fax | 319-863-9016
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Provider Business Mailing Address
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Address Line | 511 HIGHWAY 1 S
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City | WASHINGTON
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State | IA
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Zip | 52353-9782
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Country | US
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Telephone | 319-653-5494
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Fax | 319-863-9016
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 097016
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 6464
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2637
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License Number State | MN
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Taxonomy #4
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 097015
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License Number State | IA
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