Provider Demographics
NPI:1386840833
Name:MATSON, BRIAN LOREN
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:LOREN
Last Name:MATSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 238
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08525-0238
Mailing Address - Country:US
Mailing Address - Phone:609-737-7600
Mailing Address - Fax:609-737-8082
Practice Address - Street 1:109 TITUS MILL RD
Practice Address - Street 2:
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-4306
Practice Address - Country:US
Practice Address - Phone:609-737-7600
Practice Address - Fax:609-737-8082
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00460100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor