Provider Demographics
NPI:1952597080
Name:DEFILIPPIS, MATTHEW LAWRENCE (BA DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:LAWRENCE
Last Name:DEFILIPPIS
Suffix:
Gender:M
Credentials:BA DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19076 COCHRAN BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-1008
Mailing Address - Country:US
Mailing Address - Phone:941-258-3550
Mailing Address - Fax:941-258-3551
Practice Address - Street 1:19076 COCHRAN BLVD
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-2044
Practice Address - Country:US
Practice Address - Phone:941-258-3550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH00009411111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor