Provider Demographics
NPI:1811238900
Name:MATTHEW C DEMETREE DC, PA
Entity Type:Organization
Organization Name:MATTHEW C DEMETREE DC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:C
Authorized Official - Last Name:DEMETREE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-324-8222
Mailing Address - Street 1:3505 S ORLANDO DR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32773-5609
Mailing Address - Country:US
Mailing Address - Phone:407-324-8222
Mailing Address - Fax:407-324-8998
Practice Address - Street 1:3505 S ORLANDO DR
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32773-5609
Practice Address - Country:US
Practice Address - Phone:407-324-8222
Practice Address - Fax:407-324-8998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-14
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7803111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55904BMedicare PIN
FLU78631Medicare UPIN