Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC011275 | PA |
N | 111NR0400X | Rehabilitation Chiropractor | DC011275 | PA |
N | 111NS0005X | Chiropractic Sports Physician | DC011275 | PA |
NPI | 1225551401 |
---|---|
Provider Name | Dr. Matt Szczurek |
First Address | Glenside, PA 19038-3909 |
Second Address | Spring House, PA 19477-1011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2017 |
Last Update Date | 21/07/2020 |