Provider Demographics
NPI:1821154527
Name:HILL, MATTHEW JOSEPH (DC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JOSEPH
Last Name:HILL
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 1:543 SOUTH RIDGEWOOD AVENUE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-4929
Mailing Address - Country:US
Mailing Address - Phone:386-253-1113
Mailing Address - Fax:386-253-1878
Practice Address - Street 1:543 SOUTH RIDGEWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-4929
Practice Address - Country:US
Practice Address - Phone:386-253-1113
Practice Address - Fax:386-253-1878
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8693111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL89032OtherBCBS
FLU4095ZMedicare ID - Type Unspecified