Provider Demographics
NPI:1881756047
Name:SIERADSKI, MATTHEW PETERS (MACOM, LAC)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:PETERS
Last Name:SIERADSKI
Suffix:
Gender:M
Credentials:MACOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 E 15TH AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4177
Mailing Address - Country:US
Mailing Address - Phone:541-579-1153
Mailing Address - Fax:541-344-0073
Practice Address - Street 1:260 E 15TH AVE
Practice Address - Street 2:SUITE F
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4177
Practice Address - Country:US
Practice Address - Phone:541-579-1153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00907171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist