MEDICARE: DR. MATTHEW STEPHEN PHINNEY 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	2301009924	MI

General Provider Information

NPI Number	:	1538457890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW STEPHEN PHINNEY D.C

Provider Business Mailing Address
First Line	:	5747 28TH STREET SE
Second Line	:	SUITE 101
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546
Country	:	US
Telephone Number	:	616-432-3103
Fax Number	:	616-328-6364

Provider Business Practice Location Address
First Line	:	5747 28TH ST SE
Second Line	:	SUITE 101
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-6928
Country	:	US
Telephone Number	:	616-432-3103
Fax Number	:	616-328-6364

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

Provider Enumeration Date	:	07/20/2011
Last Update Date	:	04/14/2015

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