Provider Demographics
NPI:1295194942
Name:DIMATTEO, AMY (DC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:DIMATTEO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6211 DURAND AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-4956
Mailing Address - Country:US
Mailing Address - Phone:262-898-9000
Mailing Address - Fax:262-898-3030
Practice Address - Street 1:6211 DURAND AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-4956
Practice Address - Country:US
Practice Address - Phone:262-898-9000
Practice Address - Fax:262-898-3030
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5131111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor