Provider Demographics
NPI:1760712582
Name:CARBONE, MATTHEW JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JOSEPH
Last Name:CARBONE
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 1:82-86 WOLCOTT HILL RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-1252
Mailing Address - Country:US
Mailing Address - Phone:860-296-4446
Mailing Address - Fax:860-296-0041
Practice Address - Street 1:82-86 WOLCOTT HILL RD
Practice Address - Street 2:SUITE 1
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-1252
Practice Address - Country:US
Practice Address - Phone:860-296-4446
Practice Address - Fax:860-296-0041
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-29
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0018188111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor