Provider Demographics
NPI:1295823581
Name:CHASE, MATTHEW DUSTIN (DC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DUSTIN
Last Name:CHASE
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 1:17 PINE ST, 1 IRONGATE CENTER
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801
Mailing Address - Country:US
Mailing Address - Phone:518-743-0163
Mailing Address - Fax:518-743-0973
Practice Address - Street 1:17 PINE ST, 1 IRONGATE CENTER
Practice Address - Street 2:SUITE 3
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801
Practice Address - Country:US
Practice Address - Phone:518-743-0163
Practice Address - Fax:518-743-0973
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008066-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor