Provider Demographics
NPI:1538636725
Name:VAN MATRE, EMILEAH (DC)
Entity Type:Individual
Prefix:DR
First Name:EMILEAH
Middle Name:
Last Name:VAN MATRE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6351 BIRDS EYE DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46203-6171
Mailing Address - Country:US
Mailing Address - Phone:574-870-1375
Mailing Address - Fax:
Practice Address - Street 1:7651 E US HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7972
Practice Address - Country:US
Practice Address - Phone:317-272-7988
Practice Address - Fax:317-272-7918
Is Sole Proprietor?:No
Enumeration Date:2018-10-26
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08003048A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor