Provider Demographics
NPI:1336509025
Name:MATSUMOTO, LEO (DC)
Entity Type:Individual
Prefix:
First Name:LEO
Middle Name:
Last Name:MATSUMOTO
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 1:2750 E SPRING ST STE 250
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2283
Mailing Address - Country:US
Mailing Address - Phone:562-283-3332
Mailing Address - Fax:310-683-5008
Practice Address - Street 1:2750 E SPRING ST STE 250
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2283
Practice Address - Country:US
Practice Address - Phone:562-283-3332
Practice Address - Fax:310-683-5008
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-24
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC33670111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111N00000XChiropractic ProvidersChiropractor