Provider Demographics
NPI:1447389168
Name:MATTHEWS, ROMAN ADAM (DC)
Entity Type:Individual
Prefix:
First Name:ROMAN
Middle Name:ADAM
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 35
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON COURT HOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43160-0035
Mailing Address - Country:US
Mailing Address - Phone:563-508-6223
Mailing Address - Fax:
Practice Address - Street 1:1156 COLUMBUS AVE
Practice Address - Street 2:SUITE C
Practice Address - City:WASHINGTON COURT HOUSE
Practice Address - State:OH
Practice Address - Zip Code:43160-2612
Practice Address - Country:US
Practice Address - Phone:740-335-3008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRM009280111N00000X
OH3998111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor