Provider Demographics
NPI:1053636662
Name:HOWARD, MATTHEW RYAN (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:RYAN
Last Name:HOWARD
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 1:719 W LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-5941
Mailing Address - Country:US
Mailing Address - Phone:309-691-9355
Mailing Address - Fax:309-691-9357
Practice Address - Street 1:5901 N PROSPECT RD
Practice Address - Street 2:SUITE 101
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-4358
Practice Address - Country:US
Practice Address - Phone:309-691-9355
Practice Address - Fax:309-691-9357
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011668111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor