Doctor Name: | DR. DUSTIN R MATERI |
NPI Number: | 1659561629 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.C. |
License Number: | 579 |
Business Practice Address: | 207 Main St Sundance, WY - 827290971 |
Business Phone Number: | 3072834040 |
Business Fax Number: | 3072834041 |
Mailing Address: | Po Box 971, 207 Main St. SUNDANCE |
State: | WY |
Postal Code: | 827290971 |
Phone Number: | 3072834040 |
Fax Number: | 3072834041 |
NPI Enumeration Date: | 07/26/2007 |
NPI Last Update Date: | 01/04/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 111N00000X |
License Number: | 579 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WY |
Taxonomy Type: | Chiropractic Providers |
Taxonomy Classification: | Chiropractor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |