Provider Demographics
NPI:1144244815
Name:MATHENY, DAVID A (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:MATHENY
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 1:122 E PARK ST
Mailing Address - Street 2:P.O. BOX 517
Mailing Address - City:GARDNER
Mailing Address - State:KS
Mailing Address - Zip Code:66030-1343
Mailing Address - Country:US
Mailing Address - Phone:913-856-7067
Mailing Address - Fax:913-856-5760
Practice Address - Street 1:122 E PARK ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:KS
Practice Address - Zip Code:66030-1343
Practice Address - Country:US
Practice Address - Phone:913-856-7067
Practice Address - Fax:913-856-5760
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-03279111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS48-0821392OtherCOMMERCIAL INS
KS0003191AMedicare ID - Type Unspecified
KS48-0821392OtherCOMMERCIAL INS