Provider Demographics
NPI:1760617989
Name:KINGSTON, MATTHEW PHILIP (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:PHILIP
Last Name:KINGSTON
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 1:6737 FRANK LLOYD WRIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-1762
Mailing Address - Country:US
Mailing Address - Phone:608-203-6499
Mailing Address - Fax:608-203-8277
Practice Address - Street 1:1805 PASO ROBLE WAY
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53716-2418
Practice Address - Country:US
Practice Address - Phone:608-395-9663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-18
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4500-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor