Provider Demographics
NPI:1386677946
Name:MARCOTTE, MATTHEW (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:MARCOTTE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:MATTHEW
Other - Middle Name:
Other - Last Name:MARCOTTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:8611 COLUMBUS PIKE
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-9614
Mailing Address - Country:US
Mailing Address - Phone:614-839-1044
Mailing Address - Fax:740-879-2813
Practice Address - Street 1:8611 COLUMBUS PIKE
Practice Address - Street 2:
Practice Address - City:LEWIS CENTER
Practice Address - State:OH
Practice Address - Zip Code:43035-9614
Practice Address - Country:US
Practice Address - Phone:614-839-1044
Practice Address - Fax:740-879-2813
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH041340207R00000X
OH3745208100000X, 111N00000X
OH50.002737RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractor
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP30929FOtherBLUE CARE NETWORK
MI950B376090OtherBLUE CROSS
OHCH9369211Medicare PIN