Provider Demographics
NPI:1194777383
Name:DEMATTE, JOHN J IV (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:DEMATTE
Suffix:IV
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 1:1155 INTERCHANGE ROAD
Mailing Address - Street 2:
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235
Mailing Address - Country:US
Mailing Address - Phone:610-377-1900
Mailing Address - Fax:610-377-1516
Practice Address - Street 1:1155 INTERCHANGE ROAD
Practice Address - Street 2:
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235
Practice Address - Country:US
Practice Address - Phone:610-377-1900
Practice Address - Fax:610-377-1516
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006559L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA161403001Medicaid
PA161403001Medicaid
PADE869943Medicare ID - Type Unspecified