Provider Demographics
NPI:1518154301
Name:MATTES FAMILY & SPORTS CHIROPRACTIC PC
Entity Type:Organization
Organization Name:MATTES FAMILY & SPORTS CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MATTES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:641-787-0311
Mailing Address - Street 1:119 1ST AVE W
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:IA
Mailing Address - Zip Code:50208-3721
Mailing Address - Country:US
Mailing Address - Phone:641-787-0311
Mailing Address - Fax:641-792-6396
Practice Address - Street 1:119 1ST AVE W
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IA
Practice Address - Zip Code:50208-3721
Practice Address - Country:US
Practice Address - Phone:641-787-0311
Practice Address - Fax:641-792-6396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06227111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI14241Medicare PIN