Provider Demographics
NPI:1659488260
Name:SORELL, MATTHEW LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:LEE
Last Name:SORELL
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 1:400 MARK TWAIN AVE
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-3249
Mailing Address - Country:US
Mailing Address - Phone:573-221-1071
Mailing Address - Fax:573-221-1433
Practice Address - Street 1:400 MARK TWAIN AVE
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-3249
Practice Address - Country:US
Practice Address - Phone:573-221-1075
Practice Address - Fax:573-221-1433
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005021387111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor