Provider Demographics
NPI:1093862187
Name:MCNALLY, MATTHEW THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:THOMAS
Last Name:MCNALLY
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 1:1021 N SUPERIOR AVE
Mailing Address - Street 2:STE 9
Mailing Address - City:TOMAH
Mailing Address - State:WI
Mailing Address - Zip Code:54660-1100
Mailing Address - Country:US
Mailing Address - Phone:608-372-5900
Mailing Address - Fax:608-372-5800
Practice Address - Street 1:1021 N SUPERIOR AVE
Practice Address - Street 2:STE 9
Practice Address - City:TOMAH
Practice Address - State:WI
Practice Address - Zip Code:54660-1100
Practice Address - Country:US
Practice Address - Phone:608-372-5900
Practice Address - Fax:608-372-5800
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3654-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor