Provider Demographics
NPI:1881631380
Name:NUESSE, MATTHEW PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:PAUL
Last Name:NUESSE
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 1:6869 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45244-3470
Mailing Address - Country:US
Mailing Address - Phone:312-208-4208
Mailing Address - Fax:
Practice Address - Street 1:6869 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:OH
Practice Address - Zip Code:45244-3470
Practice Address - Country:US
Practice Address - Phone:513-271-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010560111N00000X
OH4380111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor