Individual
DR. MATTHEW DIETZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C., C.C.S.P
Contact information
Practice address
5815 COUNCIL ST NE, SUITE A-1, CEDAR RAPIDS, IA 52402-5893
(319) 393-1555
(319) 393-2312
Mailing address
5815 COUNCIL ST NE, SUITE A-1, CEDAR RAPIDS, IA 52402-5893
(319) 393-1555
(319) 393-2312
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
038-010487
IL
111N00000X
Chiropractor
Primary
06793
IA
111NS0005X
Sports Physician Chiropractor
038-010487
IL
111NS0005X
Sports Physician Chiropractor
06793
IA
Other
Enumeration date
03/14/2007
Last updated
10/08/2010
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