Provider Demographics
NPI:1477879542
Name:LEONARD, MATTHEW T (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:T
Last Name:LEONARD
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 1:1453 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-3251
Mailing Address - Country:US
Mailing Address - Phone:805-667-2260
Mailing Address - Fax:805-667-6642
Practice Address - Street 1:1453 E MAIN ST
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-3251
Practice Address - Country:US
Practice Address - Phone:805-667-2260
Practice Address - Fax:805-667-6642
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-14
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC31499111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor