Provider Demographics
NPI:1891083994
Name:BEHM, MATTHEW RYAN (DC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:RYAN
Last Name:BEHM
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:N83W13600 FOND DU LAC AVE UNIT 115
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-8105
Mailing Address - Country:US
Mailing Address - Phone:262-305-4485
Mailing Address - Fax:
Practice Address - Street 1:S71W23325 NATIONAL AVE STE 5
Practice Address - Street 2:
Practice Address - City:BIG BEND
Practice Address - State:WI
Practice Address - Zip Code:53103-9495
Practice Address - Country:US
Practice Address - Phone:262-662-9775
Practice Address - Fax:262-662-9773
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4649-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor