Provider Demographics
NPI:1558022145
Name:ATZORI, MATTHEW DANIEL SOARES (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DANIEL SOARES
Last Name:ATZORI
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 1:555 VICTORY COURT AVENUE SOUTH
Mailing Address - Street 2:APARTMENT 312
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377
Mailing Address - Country:US
Mailing Address - Phone:952-212-7228
Mailing Address - Fax:
Practice Address - Street 1:234 PINE CONE RD STE B
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-2504
Practice Address - Country:US
Practice Address - Phone:320-253-5255
Practice Address - Fax:320-253-5260
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6920111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor