Provider Demographics
NPI:1235297227
Name:FARIS, MATHEW GENE (DC)
Entity Type:Individual
Prefix:DR
First Name:MATHEW
Middle Name:GENE
Last Name:FARIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 STONEBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-5407
Mailing Address - Country:US
Mailing Address - Phone:810-233-0699
Mailing Address - Fax:810-233-7290
Practice Address - Street 1:2315 STONEBRIDGE DR
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-5407
Practice Address - Country:US
Practice Address - Phone:810-233-0699
Practice Address - Fax:810-233-7290
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004722111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU29901Medicare UPIN