Provider Demographics
NPI:1295971059
Name:FUNK, MATTHEW FRANCIS (DC)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:FRANCIS
Last Name:FUNK
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 1:60 LAFAYETTE ST
Mailing Address - Street 2:CHIROPRACTIC CLINIC
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-7719
Mailing Address - Country:US
Mailing Address - Phone:203-576-4347
Mailing Address - Fax:203-576-4250
Practice Address - Street 1:60 LAFAYETTE ST
Practice Address - Street 2:CHIROPRACTIC CLINIC
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-7719
Practice Address - Country:US
Practice Address - Phone:203-576-4347
Practice Address - Fax:203-576-4250
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-29
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT483111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor