Provider Demographics
NPI:1932473899
Name:MATTHYS FAMILY & SPORTS CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:MATTHYS FAMILY & SPORTS CHIROPRACTIC, LLC
Other - Org Name:MATTHYS FAMILY & SPORTS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MATTHYS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-359-4779
Mailing Address - Street 1:3475 JERSEY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2293
Mailing Address - Country:US
Mailing Address - Phone:563-359-4779
Mailing Address - Fax:563-359-4965
Practice Address - Street 1:3475 JERSEY RIDGE RD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2293
Practice Address - Country:US
Practice Address - Phone:563-359-4779
Practice Address - Fax:563-359-4965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007409305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service