Provider Demographics
NPI:1891015897
Name:RORIE, MATTHEW BRENT (DC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:BRENT
Last Name:RORIE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3738 SOLUTIONS CTR
Mailing Address - Street 2:#773738
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-0001
Mailing Address - Country:US
Mailing Address - Phone:606-326-0347
Mailing Address - Fax:630-701-1007
Practice Address - Street 1:108 OSBORNE WAY
Practice Address - Street 2:SUITE 6
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-9693
Practice Address - Country:US
Practice Address - Phone:502-867-0073
Practice Address - Fax:502-867-0560
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY5233111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100128310Medicaid
KYP400017113Medicare PIN