Provider Demographics
NPI:1538120878
Name:MATTISON, JAMES W JR (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:W
Last Name:MATTISON
Suffix:JR
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 1:480 MEMORIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-1575
Mailing Address - Country:US
Mailing Address - Phone:908-454-8808
Mailing Address - Fax:908-998-4762
Practice Address - Street 1:480 MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1575
Practice Address - Country:US
Practice Address - Phone:908-454-8808
Practice Address - Fax:908-998-4762
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00514100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ002420TSTOtherMEDICARE
NJ319723YVXPOtherMEDICARE