Provider Demographics
NPI:1841244233
Name:CAMBRIDGE CLINIC OF CHIROPRACTIC, L.C.C.
Entity Type:Organization
Organization Name:CAMBRIDGE CLINIC OF CHIROPRACTIC, L.C.C.
Other - Org Name:CAMBRIDGE CLINIC OF CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:DIPIAZZA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-423-4666
Mailing Address - Street 1:416 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:WI
Mailing Address - Zip Code:53523-9221
Mailing Address - Country:US
Mailing Address - Phone:608-423-4666
Mailing Address - Fax:
Practice Address - Street 1:416 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:WI
Practice Address - Zip Code:53523-9221
Practice Address - Country:US
Practice Address - Phone:608-423-4666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3783-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty