Provider Demographics
NPI:1962697706
Name:MATTHEW DORCHESTER, DC, CCSP, LLC
Entity type:Organization
Organization Name:MATTHEW DORCHESTER, DC, CCSP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:DORCHESTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-991-3399
Mailing Address - Street 1:8894 E RUSTY SPUR PL
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-9166
Mailing Address - Country:US
Mailing Address - Phone:480-991-3399
Mailing Address - Fax:480-905-0815
Practice Address - Street 1:18325 N ALLIED WAY
Practice Address - Street 2:SUITE 105
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85054-3105
Practice Address - Country:US
Practice Address - Phone:480-991-3399
Practice Address - Fax:480-905-0815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1578111NS0005X
AZ10597208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ117689OtherPTAN