Provider Demographics
NPI:1346317765
Name:MATTHEW A GOBEN, D.C. LTD
Entity Type:Organization
Organization Name:MATTHEW A GOBEN, D.C. LTD
Other - Org Name:CHESTER CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:ADEN
Authorized Official - Last Name:GOBEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-826-5031
Mailing Address - Street 1:987 STATE ST
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:62233-1654
Mailing Address - Country:US
Mailing Address - Phone:618-826-5031
Mailing Address - Fax:618-826-5032
Practice Address - Street 1:987 STATE ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:IL
Practice Address - Zip Code:62233-1654
Practice Address - Country:US
Practice Address - Phone:618-826-5031
Practice Address - Fax:618-826-5032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008691111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL419279OtherHEALTHLINK
IL7923183OtherBCBS
IL213277Medicare ID - Type UnspecifiedMEDICARE
IL7923183OtherBCBS