Provider Demographics
NPI:1558523399
Name:GERALD R. MATTIA D.C., P.A.
Entity Type:Organization
Organization Name:GERALD R. MATTIA D.C., P.A.
Other - Org Name:MATTIA CHIROPRACTIC AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:MATTIA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-909-4788
Mailing Address - Street 1:8915 CONROY WINDERMERE RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-3127
Mailing Address - Country:US
Mailing Address - Phone:407-909-4788
Mailing Address - Fax:407-909-1788
Practice Address - Street 1:8915 CONROY WINDERMERE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-3127
Practice Address - Country:US
Practice Address - Phone:407-909-4788
Practice Address - Fax:407-909-1788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH2832111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U27132Medicare UPIN
FLK6076Medicare PIN