Provider Demographics
NPI:1326031295
Name:MURDOCK, JAMES MATTSON (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MATTSON
Last Name:MURDOCK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:MATT
Other - Middle Name:
Other - Last Name:MURDOCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRNCNP
Mailing Address - Street 1:6531 WINFORD AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45011-0548
Mailing Address - Country:US
Mailing Address - Phone:513-863-2273
Mailing Address - Fax:513-863-6022
Practice Address - Street 1:6531 WINFORD AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45011-0548
Practice Address - Country:US
Practice Address - Phone:513-863-2273
Practice Address - Fax:513-863-6022
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.026507363LF0000X
OH2323111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHMU0805862Medicare ID - Type Unspecified