Provider Demographics
NPI:1548262231
Name:HAJZL, MATTHEW WAYNE (DC)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:WAYNE
Last Name:HAJZL
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:E10767 GORE HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:VIOLA
Mailing Address - State:WI
Mailing Address - Zip Code:54664-6800
Mailing Address - Country:US
Mailing Address - Phone:608-646-0238
Mailing Address - Fax:
Practice Address - Street 1:E10767 GORE HOLLOW RD
Practice Address - Street 2:
Practice Address - City:VIOLA
Practice Address - State:WI
Practice Address - Zip Code:54664-8014
Practice Address - Country:US
Practice Address - Phone:608-646-0238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008874111N00000X
WI4539012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU80130Medicare UPIN
IL581280Medicare ID - Type UnspecifiedPROVIDER ID