Provider Demographics
NPI:1467452789
Name:HERBER, MATTHEW S (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:S
Last Name:HERBER
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 1:502 GREENE AVE
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-2820
Mailing Address - Country:US
Mailing Address - Phone:920-965-1155
Mailing Address - Fax:920-965-1156
Practice Address - Street 1:502 GREENE AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-2820
Practice Address - Country:US
Practice Address - Phone:920-965-1155
Practice Address - Fax:920-965-1156
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3986-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38949900Medicaid
WI38949900Medicaid