Provider Demographics
NPI:1801862214
Name:COLBY, MATTHEW D (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:D
Last Name:COLBY
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 1:713 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-2104
Mailing Address - Country:US
Mailing Address - Phone:608-356-9024
Mailing Address - Fax:
Practice Address - Street 1:713 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-2104
Practice Address - Country:US
Practice Address - Phone:608-356-9024
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2360111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI391900456016OtherBCBS
WIT61680Medicare UPIN
WI75773Medicare ID - Type UnspecifiedMEDICARE