Basic Information
| Provider Information | |||||||||
| NPI: | 1346258571 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEGAETANO | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 363 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | LEWISVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750573867 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724364434 | ||||||||
| FaxNumber: | 9724363182 | ||||||||
| Practice Location | |||||||||
| Address1: | 363 W. MAIN ST | ||||||||
| Address2: | |||||||||
| City: | LEWISVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724364434 | ||||||||
| FaxNumber: | 9724363182 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 9349 | TX | Y | Chiropractic Providers | Chiropractor |
No ID Information.