Provider Demographics
NPI:1316372147
Name:MATTISON, LUKE (DC)
Entity Type:Individual
Prefix:DR
First Name:LUKE
Middle Name:
Last Name:MATTISON
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 1:600 E MAGNOLIA BLVD
Mailing Address - Street 2:APT. #306
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91501-3601
Mailing Address - Country:US
Mailing Address - Phone:818-433-1404
Mailing Address - Fax:
Practice Address - Street 1:9225 VENICE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-3324
Practice Address - Country:US
Practice Address - Phone:310-838-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32416111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor