Provider Demographics
NPI:1740684794
Name:FLOTTERUD, MATTHEW EVAN (DC, ATC)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:EVAN
Last Name:FLOTTERUD
Suffix:
Gender:M
Credentials:DC, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 HIGHWAY 1 S
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52353-9782
Mailing Address - Country:US
Mailing Address - Phone:319-653-5494
Mailing Address - Fax:319-863-9016
Practice Address - Street 1:511 HIGHWAY 1 S
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IA
Practice Address - Zip Code:52353-9782
Practice Address - Country:US
Practice Address - Phone:319-653-5494
Practice Address - Fax:319-863-9016
Is Sole Proprietor?:No
Enumeration Date:2014-10-20
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA097016111N00000X
MN6464111N00000X
MN26372255A2300X
IA0970152255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No111N00000XChiropractic ProvidersChiropractor