Provider Demographics
NPI:1700251220
Name:BRUSH, MATTHEW K (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:K
Last Name:BRUSH
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:PO BOX 143
Mailing Address - Street 2:
Mailing Address - City:VANDERGRIFT
Mailing Address - State:PA
Mailing Address - Zip Code:15690-0143
Mailing Address - Country:US
Mailing Address - Phone:724-478-1501
Mailing Address - Fax:724-478-1552
Practice Address - Street 1:2131 RIVER RD
Practice Address - Street 2:
Practice Address - City:NORTH APOLLO
Practice Address - State:PA
Practice Address - Zip Code:15673-1005
Practice Address - Country:US
Practice Address - Phone:724-478-1501
Practice Address - Fax:724-478-1552
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011096111N00000X
PAAJ010863111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation