Provider Demographics
NPI:1346753985
Name:WARO, MATTHEW W (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:W
Last Name:WARO
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 1:1195 SUMMIT AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-4494
Mailing Address - Country:US
Mailing Address - Phone:262-204-7007
Mailing Address - Fax:
Practice Address - Street 1:1195 SUMMIT AVE STE 400
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-4494
Practice Address - Country:US
Practice Address - Phone:262-204-7007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-06
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010615111N00000X
WI5406111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor