Provider Demographics
NPI:1356672075
Name:MATSUDA, ZEN (DC)
Entity Type:Individual
Prefix:
First Name:ZEN
Middle Name:
Last Name:MATSUDA
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 1:4570 WEST 77TH STREET
Mailing Address - Street 2:SUITE 140
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-7015
Mailing Address - Country:US
Mailing Address - Phone:952-500-8733
Mailing Address - Fax:763-592-8142
Practice Address - Street 1:4570 WEST 77TH STREET
Practice Address - Street 2:SUITE 140
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-7015
Practice Address - Country:US
Practice Address - Phone:952-500-8733
Practice Address - Fax:763-592-8142
Is Sole Proprietor?:No
Enumeration Date:2010-01-20
Last Update Date:2024-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5320111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1356672075Medicaid
MN1356672075Medicaid