Provider Demographics
NPI:1689956518
Name:STASEK, MATTHEW JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JOHN
Last Name:STASEK
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 1:1100 W ROYALTON RD
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-3946
Mailing Address - Country:US
Mailing Address - Phone:440-230-1113
Mailing Address - Fax:440-230-5314
Practice Address - Street 1:1100 W ROYALTON RD
Practice Address - Street 2:
Practice Address - City:BROADVIEW HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44147-3946
Practice Address - Country:US
Practice Address - Phone:440-230-1113
Practice Address - Fax:440-230-5314
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4194111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU12682Medicare UPIN