Provider Demographics
NPI:1093256588
Name:CASPERSON, MATTHEW C (DC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:C
Last Name:CASPERSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3252 51ST ST S STE A
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-7897
Mailing Address - Country:US
Mailing Address - Phone:701-730-3867
Mailing Address - Fax:701-639-0934
Practice Address - Street 1:3252 51ST ST S STE A
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-7897
Practice Address - Country:US
Practice Address - Phone:701-730-3867
Practice Address - Fax:701-639-0934
Is Sole Proprietor?:No
Enumeration Date:2017-03-16
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6337111N00000X
ND1081111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor