Provider Demographics
NPI:1972514388
Name:MATZNER, DANIEL E (DC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:E
Last Name:MATZNER
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 1:4406A FOREST DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29206-3129
Mailing Address - Country:US
Mailing Address - Phone:803-738-8286
Mailing Address - Fax:803-738-8287
Practice Address - Street 1:4406A FOREST DR
Practice Address - Street 2:SUITE 5
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29206-3129
Practice Address - Country:US
Practice Address - Phone:803-738-8286
Practice Address - Fax:803-738-8287
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3034111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGCH503Medicaid
SCU73678Medicare UPIN
SCGCH503Medicaid