Provider Demographics
NPI:1932210614
Name:MATIJASIC, BRIAN J (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:J
Last Name:MATIJASIC
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 1:2199 BABCOCK BLVD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15209-1386
Mailing Address - Country:US
Mailing Address - Phone:412-821-2600
Mailing Address - Fax:412-821-2627
Practice Address - Street 1:2199 BABCOCK BLVD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15209-1386
Practice Address - Country:US
Practice Address - Phone:412-821-2600
Practice Address - Fax:412-821-2627
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC 003152 L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001039800004Medicaid
PA001039800004Medicaid
T30615Medicare UPIN