Provider Demographics
NPI:1033139316
Name:MATTIS, ANTHONY NICHOLAS (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:NICHOLAS
Last Name:MATTIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:95 MATHEWS DR
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29926-3734
Mailing Address - Country:US
Mailing Address - Phone:843-815-2221
Mailing Address - Fax:843-815-2761
Practice Address - Street 1:1297 MAY RIVER RD
Practice Address - Street 2:SUITE 201
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910
Practice Address - Country:US
Practice Address - Phone:843-815-2221
Practice Address - Fax:843-815-2761
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC2397111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCU80589Medicare UPIN
SCU805898564Medicare PIN