Provider Demographics
NPI:1124072731
Name:JANZEN, MATTHEW I (DC)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:I
Last Name:JANZEN
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 1:5824 NW 135TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-5938
Mailing Address - Country:US
Mailing Address - Phone:408-379-0133
Mailing Address - Fax:408-379-3931
Practice Address - Street 1:5824 NW 135TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-5938
Practice Address - Country:US
Practice Address - Phone:408-379-0133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24146111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA200499248OtherCURRENT TAX ID
CA770419174OtherPREVIOUS TAX ID