Provider Demographics
NPI:1851404966
Name:MATOUSEK, SHARHAE ANGELA (DC)
Entity Type:Individual
Prefix:DR
First Name:SHARHAE
Middle Name:ANGELA
Last Name:MATOUSEK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8901 AZTEC DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347-1916
Mailing Address - Country:US
Mailing Address - Phone:952-224-0607
Mailing Address - Fax:952-224-2418
Practice Address - Street 1:8901 AZTEC DR
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55347-1916
Practice Address - Country:US
Practice Address - Phone:952-224-0607
Practice Address - Fax:952-224-2418
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3818111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN10841700Medicaid
MNC03431Medicare ID - Type Unspecified
MN10841700Medicaid