Provider Demographics
NPI:1639211568
Name:MATTEO CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:MATTEO CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:M
Authorized Official - Last Name:MATTEO
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:919-563-0000
Mailing Address - Street 1:941 S FIFTH ST
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-3240
Mailing Address - Country:US
Mailing Address - Phone:919-563-0000
Mailing Address - Fax:919-563-0063
Practice Address - Street 1:941 S FIFTH ST
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-3240
Practice Address - Country:US
Practice Address - Phone:919-563-0000
Practice Address - Fax:919-563-0063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3048111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1730128976OtherINDIVIDUAL NPI
NC2454494COtherMEDICARE ID
NC89085GXMedicaid
NC1730128976OtherINDIVIDUAL NPI
NC2454494COtherMEDICARE ID