Provider Demographics
NPI:1407947252
Name:NIRSCHL CH, MATT R
Entity Type:Individual
Prefix:
First Name:MATT
Middle Name:R
Last Name:NIRSCHL CH
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 1:53 NORTH OLD KINGS RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5176
Mailing Address - Country:US
Mailing Address - Phone:386-672-6565
Mailing Address - Fax:
Practice Address - Street 1:53 NORTH OLD KINGS RD
Practice Address - Street 2:SUITE C
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5176
Practice Address - Country:US
Practice Address - Phone:386-672-6565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8831111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAA699ZMedicare PIN
FLV11268Medicare UPIN