Provider Demographics
NPI:1053488460
Name:GOBEN, MATTHEW ADEN (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ADEN
Last Name:GOBEN
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 1:311 S MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:WEBSTER GROVES
Mailing Address - State:MO
Mailing Address - Zip Code:63119-3823
Mailing Address - Country:US
Mailing Address - Phone:314-961-4172
Mailing Address - Fax:
Practice Address - Street 1:987 STATE ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:IL
Practice Address - Zip Code:62233-1654
Practice Address - Country:US
Practice Address - Phone:618-826-5031
Practice Address - Fax:618-826-5032
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008691111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL419279OtherHEALTHLINK
IL7923183OtherBCBS
IL7923183OtherBCBS
K26322Medicare ID - Type Unspecified