Provider Demographics
NPI:1326180951
Name:HILGEFORT, MATTHEW THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:THOMAS
Last Name:HILGEFORT
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 1:40 WALTER CT
Mailing Address - Street 2:
Mailing Address - City:MOSCOW MILLS
Mailing Address - State:MO
Mailing Address - Zip Code:63362-1197
Mailing Address - Country:US
Mailing Address - Phone:636-356-5557
Mailing Address - Fax:636-356-5558
Practice Address - Street 1:40 WALTER CT
Practice Address - Street 2:
Practice Address - City:MOSCOW MILLS
Practice Address - State:MO
Practice Address - Zip Code:63362-1197
Practice Address - Country:US
Practice Address - Phone:636-356-5557
Practice Address - Fax:636-356-5558
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004010186111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO274768OtherGHP
MO665379OtherUNITED HEALTH CARE
MO195807OtherBLUE CROSS BLUE SHIELD
MO713979OtherHEALTHLINK
MO7171684OtherAETNA
MOV03758Medicare UPIN
MO274768OtherGHP