Provider Demographics
NPI:1306293493
Name:LETO, MATTHEW (DC)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:LETO
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 1:3201 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-2239
Mailing Address - Country:US
Mailing Address - Phone:720-675-8334
Mailing Address - Fax:720-441-0481
Practice Address - Street 1:3201 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-2239
Practice Address - Country:US
Practice Address - Phone:720-675-8334
Practice Address - Fax:720-441-0481
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0007189111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor