Provider Demographics
NPI:1740379908
Name:MAYO, MATTHEW CLAYTON (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:CLAYTON
Last Name:MAYO
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 1:5231 E FRONTAGE HWY 52 RD NW
Mailing Address - Street 2:SUITE 201 & 202
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-4156
Mailing Address - Country:US
Mailing Address - Phone:507-280-6186
Mailing Address - Fax:507-280-7682
Practice Address - Street 1:5231 E FRONTAGE HWY 52 RD NW
Practice Address - Street 2:SUITE 201 & 202
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-4156
Practice Address - Country:US
Practice Address - Phone:507-280-6186
Practice Address - Fax:507-280-7682
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3295111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN471213700Medicaid
MN01B79MAOtherBCBS OF MN
MN350003518Medicare ID - Type Unspecified
MN471213700Medicaid