Provider Demographics
NPI:1528760964
Name:MIDDLETON, MATT ALLAN (DC)
Entity type:Individual
Prefix:DR
First Name:MATT
Middle Name:ALLAN
Last Name:MIDDLETON
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 1:2713 BATTLEFIELD PKWY
Mailing Address - Street 2:
Mailing Address - City:FORT OGLETHORPE
Mailing Address - State:GA
Mailing Address - Zip Code:30742-4039
Mailing Address - Country:US
Mailing Address - Phone:817-721-2959
Mailing Address - Fax:
Practice Address - Street 1:136 W BELMONT DR STE 4
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-3064
Practice Address - Country:US
Practice Address - Phone:706-659-2122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010985111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor