Provider Demographics
NPI:1073723839
Name:MATTEO FAMILY CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:MATTEO FAMILY CHIROPRACTIC, INC.
Other - Org Name:MATTEO FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MATTEO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-686-4222
Mailing Address - Street 1:58 SHELTER COVE LN
Mailing Address - Street 2:SUITE H
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29928-3571
Mailing Address - Country:US
Mailing Address - Phone:843-686-4222
Mailing Address - Fax:843-686-2148
Practice Address - Street 1:58 SHELTER COVE LN
Practice Address - Street 2:SUITE H
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29928-3571
Practice Address - Country:US
Practice Address - Phone:843-686-4222
Practice Address - Fax:843-686-2148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2524111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2524Medicaid
SCCH2524Medicaid
SC=========OtherTAX ID NUMBER