Provider Demographics
NPI:1003989062
Name:MATSUDA, ERIC T (DC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:T
Last Name:MATSUDA
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 1:11130 MAGNOLIA AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-3673
Mailing Address - Country:US
Mailing Address - Phone:951-688-6665
Mailing Address - Fax:951-688-6006
Practice Address - Street 1:11130 MAGNOLIA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-3673
Practice Address - Country:US
Practice Address - Phone:951-688-6665
Practice Address - Fax:951-688-6006
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23553111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor