Provider Demographics
NPI:1376674929
Name:MATSUNO, HIROYUKI (DC)
Entity Type:Individual
Prefix:
First Name:HIROYUKI
Middle Name:
Last Name:MATSUNO
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 1:1317 18TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-3424
Mailing Address - Country:US
Mailing Address - Phone:541-726-7151
Mailing Address - Fax:
Practice Address - Street 1:1317 18TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-3424
Practice Address - Country:US
Practice Address - Phone:541-726-7151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27-3137111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR104053Medicare ID - Type Unspecified