Provider Demographics
NPI:1225430762
Name:DODA, MATTHEW (DC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:DODA
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 1:976 GRAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:ST. PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105
Mailing Address - Country:US
Mailing Address - Phone:906-282-7119
Mailing Address - Fax:
Practice Address - Street 1:976 GRAND AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-3014
Practice Address - Country:US
Practice Address - Phone:906-282-7119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5888111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor