Provider Demographics
NPI:1164714887
Name:MATHESON CHIROPRACTIC & WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:MATHESON CHIROPRACTIC & WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MATHESON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-783-4994
Mailing Address - Street 1:515 N NEEL ST
Mailing Address - Street 2:BLDG C, SUITE 105
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-2284
Mailing Address - Country:US
Mailing Address - Phone:509-783-4994
Mailing Address - Fax:509-783-5494
Practice Address - Street 1:515 N NEEL ST
Practice Address - Street 2:BLDG C, SUITE 105
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2284
Practice Address - Country:US
Practice Address - Phone:509-783-4994
Practice Address - Fax:509-783-5494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60176125111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty