Provider Demographics
NPI:1609932953
Name:MICHAUD, MATTHEW (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:MICHAUD
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 1:1939 MAYBANK HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-2170
Mailing Address - Country:US
Mailing Address - Phone:843-795-1999
Mailing Address - Fax:843-795-1981
Practice Address - Street 1:1939 MAYBANK HIGHWAY
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-2170
Practice Address - Country:US
Practice Address - Phone:843-795-1999
Practice Address - Fax:843-795-1981
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA04-2774205111N00000X
SC3676111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY39905OtherBLUE CROSS BLUE SHIELD
MAY49217Medicare ID - Type Unspecified