Provider Demographics
NPI:1396229332
Name:CHIVARI, MATTHEW A
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:A
Last Name:CHIVARI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 DONALD ST
Mailing Address - Street 2:
Mailing Address - City:HINCKLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60520-9395
Mailing Address - Country:US
Mailing Address - Phone:708-227-8147
Mailing Address - Fax:
Practice Address - Street 1:620 DONALD ST
Practice Address - Street 2:
Practice Address - City:HINCKLEY
Practice Address - State:IL
Practice Address - Zip Code:60520-9395
Practice Address - Country:US
Practice Address - Phone:708-227-8147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-15
Last Update Date:2018-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency