Provider Demographics
NPI:1417141060
Name:MATHEWS, MARSHALL S (DC)
Entity Type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:S
Last Name:MATHEWS
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 1:8131 W. KLAMATH CT
Mailing Address - Street 2:STE H
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336
Mailing Address - Country:US
Mailing Address - Phone:509-736-5456
Mailing Address - Fax:509-735-9868
Practice Address - Street 1:8131 W. KLAMATH CT
Practice Address - Street 2:STE H
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336
Practice Address - Country:US
Practice Address - Phone:509-736-5456
Practice Address - Fax:509-735-9868
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60048137111N00000X
AZ7849111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8876986Medicare PIN