Provider Demographics
NPI:1205986601
Name:DR. JAMES C. MATTERN, PC
Entity type:Organization
Organization Name:DR. JAMES C. MATTERN, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:MATTERN
Authorized Official - Suffix:
Authorized Official - Credentials:DC, PC
Authorized Official - Phone:765-463-7337
Mailing Address - Street 1:1231 CUMBERLAND AVE D
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-1358
Mailing Address - Country:US
Mailing Address - Phone:765-463-7337
Mailing Address - Fax:765-497-4393
Practice Address - Street 1:1231 CUMBERLAND AVE D
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-1358
Practice Address - Country:US
Practice Address - Phone:765-463-7337
Practice Address - Fax:765-497-4393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001204A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN00630OtherANTHEM MEDICAID
IN000000092081OtherANTHEM BCBS PROVIDER NUMB
IN000000092081OtherANTHEM BCBS PROVIDER NUMB