Provider Demographics
NPI:1700875853
Name:HITCHNER, MATTHEW S (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:S
Last Name:HITCHNER
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 1:523 QUEEN CITY AVE
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-1513
Mailing Address - Country:US
Mailing Address - Phone:205-248-7656
Mailing Address - Fax:205-248-7768
Practice Address - Street 1:523 QUEEN CITY AVE
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-1513
Practice Address - Country:US
Practice Address - Phone:205-248-7656
Practice Address - Fax:205-248-7768
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1341111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1341OtherST BD OF CHIRO LIC NO
AL051538545Medicare PIN
AL1341OtherST BD OF CHIRO LIC NO