Provider Demographics
NPI:1194907725
Name:MATTHEWS CHIROPRACTIC CENTER PA
Entity type:Organization
Organization Name:MATTHEWS CHIROPRACTIC CENTER PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ANDRO
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:501-362-8195
Mailing Address - Street 1:706 W QUITMAN ST
Mailing Address - Street 2:
Mailing Address - City:HEBER SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72543-3752
Mailing Address - Country:US
Mailing Address - Phone:501-362-8195
Mailing Address - Fax:501-362-0817
Practice Address - Street 1:706 W QUITMAN ST
Practice Address - Street 2:
Practice Address - City:HEBER SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72543-3752
Practice Address - Country:US
Practice Address - Phone:501-362-8195
Practice Address - Fax:501-362-0817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1233111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR135498718Medicaid