Provider Demographics
NPI:1679634067
Name:HUNTER, MATTHEW JOHN ERNST (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JOHN ERNST
Last Name:HUNTER
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 1:2409 MALL DRIVE
Mailing Address - Street 2:STE C
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9841
Mailing Address - Country:US
Mailing Address - Phone:843-410-7201
Mailing Address - Fax:843-410-7203
Practice Address - Street 1:2409 MALL DRIVE
Practice Address - Street 2:STE C
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9841
Practice Address - Country:US
Practice Address - Phone:843-410-7201
Practice Address - Fax:843-410-7203
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3209111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH3209Medicaid
8958OtherMEDICARE PTAN