Provider Demographics
NPI:1194771279
Name:KRIEWALL, MATTHEW JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JAMES
Last Name:KRIEWALL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 W DRAKE RD
Mailing Address - Street 2:SUITE #102
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-2645
Mailing Address - Country:US
Mailing Address - Phone:970-224-5005
Mailing Address - Fax:970-266-2715
Practice Address - Street 1:1002 W DRAKE RD
Practice Address - Street 2:SUITE #102
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-2645
Practice Address - Country:US
Practice Address - Phone:970-224-5005
Practice Address - Fax:970-266-2715
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28-17920-0000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor