Provider Demographics
NPI:1245385996
Name:MATHIAS, STUART ALAN (DC)
Entity Type:Individual
Prefix:MR
First Name:STUART
Middle Name:ALAN
Last Name:MATHIAS
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 398
Mailing Address - Street 2:402 MAIN ST
Mailing Address - City:OLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19547-0398
Mailing Address - Country:US
Mailing Address - Phone:610-987-9227
Mailing Address - Fax:
Practice Address - Street 1:402 MAIN ST
Practice Address - Street 2:
Practice Address - City:OLEY
Practice Address - State:PA
Practice Address - Zip Code:19547-0398
Practice Address - Country:US
Practice Address - Phone:610-987-9227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005460L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0256001OtherCAPITAL BLUE CROSS ASHN
PA0794842000OtherKEYSTONE HEALTH PLAN EAST
PAMA707450OtherINDEPENDENCE BLUE CROSS
PA0794842000OtherKEYSTONE HEALTH PLAN EAST
PAMA707450OtherINDEPENDENCE BLUE CROSS