Provider Demographics
NPI:1487862868
Name:MATTHISEN, BARRY (DC)
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:
Last Name:MATTHISEN
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 1:1000 E DIMOND BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-2008
Mailing Address - Country:US
Mailing Address - Phone:907-349-4212
Mailing Address - Fax:907-344-3381
Practice Address - Street 1:1000 E DIMOND BLVD STE 202
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-2029
Practice Address - Country:US
Practice Address - Phone:907-349-4212
Practice Address - Fax:907-344-3381
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK228111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCH1228Medicaid
AKCH1228Medicaid