Provider Demographics
NPI:1750771432
Name:THRONSON, MATTHEW THEODORE (DC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:THEODORE
Last Name:THRONSON
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 1:16137 FLAGSTAFF CT N
Mailing Address - Street 2:
Mailing Address - City:ROSEMOUNT
Mailing Address - State:MN
Mailing Address - Zip Code:55068-1275
Mailing Address - Country:US
Mailing Address - Phone:715-533-0305
Mailing Address - Fax:
Practice Address - Street 1:16137 FLAGSTAFF CT N
Practice Address - Street 2:
Practice Address - City:ROSEMOUNT
Practice Address - State:MN
Practice Address - Zip Code:55068-1275
Practice Address - Country:US
Practice Address - Phone:715-533-0305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6020111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor