Provider Demographics
NPI:1316231749
Name:KLEMM, MATTHEW MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:MICHAEL
Last Name:KLEMM
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 1:7 MELGROVE LN
Mailing Address - Street 2:STE 101
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-2275
Mailing Address - Country:US
Mailing Address - Phone:573-248-1393
Mailing Address - Fax:573-248-2189
Practice Address - Street 1:7 MELGROVE LN
Practice Address - Street 2:SUITE 101
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-2275
Practice Address - Country:US
Practice Address - Phone:573-248-1393
Practice Address - Fax:573-248-2189
Is Sole Proprietor?:No
Enumeration Date:2011-06-02
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011013944111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor