Provider Demographics
NPI:1134314586
Name:FERRAZ-SOUZA, MATEUS (DC)
Entity Type:Individual
Prefix:
First Name:MATEUS
Middle Name:
Last Name:FERRAZ-SOUZA
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 1:220 ROBERT ST S
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55107-1677
Mailing Address - Country:US
Mailing Address - Phone:651-222-1155
Mailing Address - Fax:651-222-1188
Practice Address - Street 1:220 ROBERT ST S
Practice Address - Street 2:SUITE 104
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55107-1677
Practice Address - Country:US
Practice Address - Phone:651-222-1155
Practice Address - Fax:651-222-1188
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4992111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor