Provider Demographics
NPI:1104129691
Name:MATTHEW C. RICH CHIROPRACTIC LLC
Entity type:Organization
Organization Name:MATTHEW C. RICH CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:C
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:814-765-8301
Mailing Address - Street 1:PO BOX 647
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16830-0647
Mailing Address - Country:US
Mailing Address - Phone:814-765-8301
Mailing Address - Fax:814-768-4735
Practice Address - Street 1:6247 CLEARFIELD WOODLAND HWY
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830-1004
Practice Address - Country:US
Practice Address - Phone:814-765-8301
Practice Address - Fax:814-768-4735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-8651111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001338711OtherBLUE SHIELD
PA0018655500002Medicaid
PA0018655500002Medicaid
PAU88536Medicare UPIN