Provider Demographics
NPI:1679718118
Name:HOLSTEIN, MATTHEW AUGUST (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:AUGUST
Last Name:HOLSTEIN
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 1:1300 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46122-1983
Mailing Address - Country:US
Mailing Address - Phone:317-745-5111
Mailing Address - Fax:317-745-2435
Practice Address - Street 1:1300 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-1983
Practice Address - Country:US
Practice Address - Phone:317-745-5111
Practice Address - Fax:317-745-2435
Is Sole Proprietor?:No
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004027760111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor