Provider Demographics
NPI:1093894396
Name:AUTERA, MATHEW (DC)
Entity Type:Individual
Prefix:
First Name:MATHEW
Middle Name:
Last Name:AUTERA
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:PO BOX 2466
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-0466
Mailing Address - Country:US
Mailing Address - Phone:770-487-5211
Mailing Address - Fax:770-487-5950
Practice Address - Street 1:1952 HIGHWAY 54 W
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-4781
Practice Address - Country:US
Practice Address - Phone:770-487-5211
Practice Address - Fax:770-487-5950
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4867111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCCXRMedicare ID - Type Unspecified
GAU42024Medicare UPIN