Provider Demographics
NPI:1790934537
Name:MATTSON, BROCK WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:BROCK
Middle Name:WILLIAM
Last Name:MATTSON
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 1:150 BUCKSPORT RD.
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605
Mailing Address - Country:US
Mailing Address - Phone:207-667-4678
Mailing Address - Fax:207-667-4679
Practice Address - Street 1:150 BUCKSPORT RD
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-2224
Practice Address - Country:US
Practice Address - Phone:207-667-4678
Practice Address - Fax:207-667-4679
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03563111N00000X
MECR1906111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor