Provider Demographics
NPI:1669458006
Name:MATIJASIC, WILLIAM ALBIN (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ALBIN
Last Name:MATIJASIC
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 1:4500 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:VERMILION
Mailing Address - State:OH
Mailing Address - Zip Code:44089-1912
Mailing Address - Country:US
Mailing Address - Phone:440-967-8077
Mailing Address - Fax:440-967-0591
Practice Address - Street 1:4500 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:VERMILION
Practice Address - State:OH
Practice Address - Zip Code:44089-1912
Practice Address - Country:US
Practice Address - Phone:440-967-8077
Practice Address - Fax:440-967-0591
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH789111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
0475043Medicare ID - Type Unspecified
T47120Medicare UPIN