Provider Demographics
NPI:1053358085
Name:HOOPER, MATTHEW G (DC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:G
Last Name:HOOPER
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 1:4350 E RAY RD STE 110
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-4704
Mailing Address - Country:US
Mailing Address - Phone:480-652-1234
Mailing Address - Fax:480-361-7719
Practice Address - Street 1:4350 E RAY RD STE 110
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-4704
Practice Address - Country:US
Practice Address - Phone:480-652-1234
Practice Address - Fax:480-361-7719
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29064111N00000X
AZ8171111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ144773Medicare Oscar/Certification