Provider Demographics
NPI:1407140684
Name:MATLOCK CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:MATLOCK CHIROPRACTIC LLC
Other - Org Name:THE MATLOCK CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:MATLOK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:908-859-0300
Mailing Address - Street 1:291 PICKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-1626
Mailing Address - Country:US
Mailing Address - Phone:908-859-0300
Mailing Address - Fax:
Practice Address - Street 1:291 PICKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1626
Practice Address - Country:US
Practice Address - Phone:908-859-0300
Practice Address - Fax:908-859-0315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-05
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty