Provider Demographics
NPI:1801132303
Name:NEUBAUER, MATTHEW DANIEL (DC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DANIEL
Last Name:NEUBAUER
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 1:20 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-1020
Mailing Address - Country:US
Mailing Address - Phone:952-442-9876
Mailing Address - Fax:952-442-2494
Practice Address - Street 1:20 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WACONIA
Practice Address - State:MN
Practice Address - Zip Code:55387-1020
Practice Address - Country:US
Practice Address - Phone:952-442-9876
Practice Address - Fax:952-442-2494
Is Sole Proprietor?:No
Enumeration Date:2013-01-02
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5745111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5745OtherDOCTOR OF CHIROPRACTIC STATE LICENSE