Provider Demographics
NPI:1164622502
Name:MATTHEWS FAMILY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:MATTHEWS FAMILY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-845-0699
Mailing Address - Street 1:9808 NORTHEAST PKWY
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-3742
Mailing Address - Country:US
Mailing Address - Phone:704-845-0699
Mailing Address - Fax:704-841-1808
Practice Address - Street 1:9808 NORTHEAST PKWY
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-3742
Practice Address - Country:US
Practice Address - Phone:704-845-0699
Practice Address - Fax:704-841-1808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890946EMedicaid
NC0846EOtherBLUE CROSS BLUE SHIELD
NC2446693Medicare PIN
NC2446703Medicare PIN
NCT65176Medicare UPIN