Provider Demographics
NPI:1104933993
Name:ASHKETTLE, MATTHEW P (DC)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:P
Last Name:ASHKETTLE
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 1:5791 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-2831
Mailing Address - Country:US
Mailing Address - Phone:614-901-9695
Mailing Address - Fax:614-901-9720
Practice Address - Street 1:5791 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-2831
Practice Address - Country:US
Practice Address - Phone:614-901-9695
Practice Address - Fax:614-901-9720
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3257111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOH2365784Medicaid
OHOH2365784Medicaid