Provider Demographics
NPI:1801984828
Name:MCILRATH, MATTHEW J AY (DC)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:J AY
Last Name:MCILRATH
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 1:1201 PHILADELPHIA PIKE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19809-2042
Mailing Address - Country:US
Mailing Address - Phone:302-798-7033
Mailing Address - Fax:
Practice Address - Street 1:1201 PHILADELPHIA PIKE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19809-2042
Practice Address - Country:US
Practice Address - Phone:302-798-7033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF10000366111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG02239H01Medicare ID - Type Unspecified
DEU42224Medicare UPIN