Provider Demographics
NPI:1407958473
Name:MATTHEWS, COREY (DC)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:MATTHEWS
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:PO BOX 7442
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83707-1442
Mailing Address - Country:US
Mailing Address - Phone:208-343-6900
Mailing Address - Fax:208-343-0642
Practice Address - Street 1:403 S 11TH ST
Practice Address - Street 2:SUITE #110
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6968
Practice Address - Country:US
Practice Address - Phone:208-343-6900
Practice Address - Fax:208-343-0642
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-802111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDC1542OtherBLUE CROSS
ID000010006850OtherBLUE SHIELD
IDC1542OtherBLUE CROSS
IDU59647Medicare UPIN