Provider Demographics
NPI:1093056178
Name:VIEJO, MATTHEW PETER (DC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:PETER
Last Name:VIEJO
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:PO BOX 2143
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-8943
Mailing Address - Country:US
Mailing Address - Phone:918-706-5089
Mailing Address - Fax:
Practice Address - Street 1:1605 S EUCALYPTUS AVE STE 100
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-5996
Practice Address - Country:US
Practice Address - Phone:918-706-5089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-14
Last Update Date:2014-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4091111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor