Provider Demographics
NPI:1285838755
Name:JOHNS, MATTHEW CHRISTOPHER (BS, DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:CHRISTOPHER
Last Name:JOHNS
Suffix:
Gender:M
Credentials:BS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 MIFFLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:SHILLINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19607-2833
Mailing Address - Country:US
Mailing Address - Phone:610-775-9729
Mailing Address - Fax:610-777-8799
Practice Address - Street 1:30 MIFFLIN BLVD
Practice Address - Street 2:
Practice Address - City:SHILLINGTON
Practice Address - State:PA
Practice Address - Zip Code:19607-2833
Practice Address - Country:US
Practice Address - Phone:610-775-9729
Practice Address - Fax:610-777-8799
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004366L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAJO604343OtherMAJOR MEDICAL
PA604343Medicare ID - Type UnspecifiedMEDICARE