Provider Demographics
NPI:1174661300
Name:ENNEKING, MATTHEW LEON (DC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:LEON
Last Name:ENNEKING
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 1:7048 STATE ROAD 229
Mailing Address - Street 2:
Mailing Address - City:METAMORA
Mailing Address - State:IN
Mailing Address - Zip Code:47030-9600
Mailing Address - Country:US
Mailing Address - Phone:812-934-4965
Mailing Address - Fax:
Practice Address - Street 1:128 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:IN
Practice Address - Zip Code:47006-4814
Practice Address - Country:US
Practice Address - Phone:812-933-5757
Practice Address - Fax:812-932-3303
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002272A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor