Provider Demographics
NPI:1487922894
Name:POTRATZ, MATTHEW PAUL (DC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:PAUL
Last Name:POTRATZ
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 1:813 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:IA
Mailing Address - Zip Code:51601-2301
Mailing Address - Country:US
Mailing Address - Phone:712-246-5954
Mailing Address - Fax:712-246-3269
Practice Address - Street 1:813 CHURCH ST
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:IA
Practice Address - Zip Code:51601-2301
Practice Address - Country:US
Practice Address - Phone:712-246-5954
Practice Address - Fax:712-246-3269
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007472111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor