MEDICARE: DR. MATTHEW LEE WHEELER D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2008023699	MO

General Provider Information

NPI Number	:	1114183753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW LEE WHEELER D.C.

Provider Business Mailing Address
First Line	:	2476 TAYLOR RD
Second Line	:
City	:	WILDWOOD
State	:	MO
Zip	:	63040-1222
Country	:	US
Telephone Number	:	636-458-7575
Fax Number	:	636-458-7979

Provider Business Practice Location Address
First Line	:	2476 TAYLOR RD
Second Line	:
City	:	WILDWOOD
State	:	MO
Zip	:	63040-1222
Country	:	US
Telephone Number	:	636-458-7575
Fax Number	:	636-458-7979

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2008
Last Update Date	:	08/04/2008

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