Provider Demographics
NPI:1487328316
Name:TRINIDAD, MATTHEW LORENZO (DC)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:LORENZO
Last Name:TRINIDAD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1430
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-9230
Mailing Address - Country:US
Mailing Address - Phone:219-763-8112
Mailing Address - Fax:219-764-5333
Practice Address - Street 1:1828 165TH ST STE A
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46320-2823
Practice Address - Country:US
Practice Address - Phone:219-763-8112
Practice Address - Fax:219-764-5333
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08003217A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor