Provider Demographics
NPI:1700698024
Name:INFUSINO, MATEO E (DC)
Entity type:Individual
Prefix:
First Name:MATEO
Middle Name:E
Last Name:INFUSINO
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 1:5024 GREEN BAY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-1702
Mailing Address - Country:US
Mailing Address - Phone:262-657-8434
Mailing Address - Fax:262-657-8435
Practice Address - Street 1:5024 GREEN BAY RD STE 100
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-1702
Practice Address - Country:US
Practice Address - Phone:262-657-8434
Practice Address - Fax:262-657-8435
Is Sole Proprietor?:No
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6237-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor