Provider Demographics
NPI:1528127628
Name:SYREK, MATTHEW R (DC)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:R
Last Name:SYREK
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 1:123 E. WILLIAM STREET
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537
Mailing Address - Country:US
Mailing Address - Phone:419-893-0231
Mailing Address - Fax:419-891-6900
Practice Address - Street 1:123 E. WILLIAM STREET
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537
Practice Address - Country:US
Practice Address - Phone:419-893-0231
Practice Address - Fax:419-891-6900
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3453111NS0005X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3123926Medicaid
OH3123926Medicaid