Provider Demographics
NPI:1497996334
Name:MATTHEW N PARRIS DC PA
Entity Type:Organization
Organization Name:MATTHEW N PARRIS DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:N
Authorized Official - Last Name:PARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:772-299-4649
Mailing Address - Street 1:2601 20TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6632
Mailing Address - Country:US
Mailing Address - Phone:772-299-4649
Mailing Address - Fax:772-569-9914
Practice Address - Street 1:2601 20TH ST STE A
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6632
Practice Address - Country:US
Practice Address - Phone:772-299-4649
Practice Address - Fax:772-299-4651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-23
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8349111N00000X, 111NR0200X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NR0200XChiropractic ProvidersChiropractorRadiologyGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70153Medicare PIN
FLU89099Medicare UPIN