Provider Demographics
NPI:1689772881
Name:DEMETREE, MATTHEW CHARLES (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:CHARLES
Last Name:DEMETREE
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 1:3505 S ORLANDO DR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32773-5609
Mailing Address - Country:US
Mailing Address - Phone:407-324-8222
Mailing Address - Fax:407-682-4376
Practice Address - Street 1:3505 S ORLANDO DR
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32773-5609
Practice Address - Country:US
Practice Address - Phone:407-324-8222
Practice Address - Fax:407-682-4376
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7803111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20-8240320OtherTAX IDENTIFICATION
FLU78631Medicare UPIN
FL55904BMedicare ID - Type Unspecified