Provider Demographics
NPI:1447625470
Name:CHADWICK, MATTHEW
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:CHADWICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-3363
Mailing Address - Country:US
Mailing Address - Phone:870-882-0808
Mailing Address - Fax:
Practice Address - Street 1:2505 AGGIE ROAD
Practice Address - Street 2:
Practice Address - City:STATE UNIVERSITY
Practice Address - State:AR
Practice Address - Zip Code:72467
Practice Address - Country:US
Practice Address - Phone:870-972-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer