Provider Demographics
NPI:1275684904
Name:LANUM, MATTHEW G (DC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:G
Last Name:LANUM
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 1:40 MORRISTOWN RD
Mailing Address - Street 2:SUITE 1E
Mailing Address - City:BERNARDSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07924-2310
Mailing Address - Country:US
Mailing Address - Phone:908-221-1334
Mailing Address - Fax:
Practice Address - Street 1:40 MORRISTOWN RD
Practice Address - Street 2:SUITE 1E
Practice Address - City:BERNARDSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07924-2310
Practice Address - Country:US
Practice Address - Phone:908-221-1334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00462500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU56122Medicare UPIN