Provider Demographics
NPI:1013558865
Name:DEAN, MATTHEW C (DC MS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:C
Last Name:DEAN
Suffix:
Gender:M
Credentials:DC MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 SE 89TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2053
Mailing Address - Country:US
Mailing Address - Phone:503-771-5555
Mailing Address - Fax:
Practice Address - Street 1:2440 SE 89TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2053
Practice Address - Country:US
Practice Address - Phone:503-771-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6027111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor