Provider Demographics
NPI:1295189744
Name:DR. MATTHEW DUMOND, LLC
Entity Type:Organization
Organization Name:DR. MATTHEW DUMOND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:DUMOND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-647-2119
Mailing Address - Street 1:20401 COUNTY HWY SR
Mailing Address - Street 2:
Mailing Address - City:RICHLAND CENTER
Mailing Address - State:WI
Mailing Address - Zip Code:53581-6266
Mailing Address - Country:US
Mailing Address - Phone:608-647-2119
Mailing Address - Fax:608-647-7539
Practice Address - Street 1:20401 COUNTY HWY SR
Practice Address - Street 2:
Practice Address - City:RICHLAND CENTER
Practice Address - State:WI
Practice Address - Zip Code:53581-6266
Practice Address - Country:US
Practice Address - Phone:608-647-2119
Practice Address - Fax:608-647-7539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1377111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38830700Medicaid
WI38830700Medicaid
WIT61814Medicare UPIN