Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 4037-012 | WI |
NPI | 1033269394 |
---|---|
Provider Name | Matthew John Schwab |
First Address | Eau Claire, WI 54701-6144 |
Second Address | Eau Claire, WI 54701-6144 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
35627 | (02) | WI |