Provider Demographics
NPI:1679762504
Name:HOFFMAN, MATTHEW PATRICK (DC)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:PATRICK
Last Name:HOFFMAN
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 1:662 N CONVENT ST
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-1329
Mailing Address - Country:US
Mailing Address - Phone:815-937-0446
Mailing Address - Fax:815-937-0487
Practice Address - Street 1:662 N CONVENT ST
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-1329
Practice Address - Country:US
Practice Address - Phone:815-937-0446
Practice Address - Fax:815-937-0487
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007367111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04622727OtherBCBS
IL469950Medicare PIN
IL04622727OtherBCBS
ILU71387Medicare UPIN