Active NPI
Matthew Lee Davidson, D.C.
- Sports Physician Chiropractor
- Washington, MO
National Provider Identifier
1255624508
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Physician Chiropractor
- License
- 2011012876
- Practice address
- 1809 Heritage Hills Dr
Washington, MO 63090-4624 - Phone
- (636) 239-5252
- Fax
- (636) 239-4499
- NPI assigned
- May 19, 2011
- Last updated
- Apr 17, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Physician Chiropractor | 111NS0005X | 2011012876 | MO | Primary |
Addresses
Primary practice location
1809 Heritage Hills Dr
Washington, MO 63090-4624
Mailing address
1809 Heritage Hills Center Drive
Washington, MO 43090-4624
Phone (636) 239-5252
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Logan College of Chiropractic, 2010
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
355 Ozark Trail Dr
Suite 9
Ellisville, MO 63011-2164
Phone (636) 394-2225
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba West County Spine & Joint
- Sports Physician Chiropractor
- Ellisville, MO
- NPI 1487954434
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1305763200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1492387200000",
"number": "1255624508",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1809 HERITAGE HILLS CENTER DRIVE",
"city": "WASHINGTON",
"state": "MO",
"postal_code": "430904624",
"telephone_number": "636-239-5252",
"fax_number": "636-239-4499"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1809 HERITAGE HILLS DR",
"city": "WASHINGTON",
"state": "MO",
"postal_code": "630904624",
"telephone_number": "636-239-5252",
"fax_number": "636-239-4499"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIDSON",
"first_name": "MATTHEW",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-05-19",
"last_updated": "2017-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "111NS0005X",
"taxonomy_group": "",
"desc": "Chiropractor, Sports Physician",
"state": "MO",
"license": "2011012876",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Washington, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.