Provider Demographics
NPI:1104977313
Name:BARTON, MATTHEW JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JAMES
Last Name:BARTON
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 1:1122 LEONARD ST NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-1234
Mailing Address - Country:US
Mailing Address - Phone:616-459-8552
Mailing Address - Fax:616-459-8562
Practice Address - Street 1:1122 LEONARD ST NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-1234
Practice Address - Country:US
Practice Address - Phone:616-459-8552
Practice Address - Fax:616-459-8562
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI007668111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950D17681OtherBCBSM
MI3469331Medicaid
MIM22710004Medicare ID - Type Unspecified
MI3469331Medicaid