Provider Demographics
NPI:1558356329
Name:MATTHEW R. GAGE, D.C.,P.A.
Entity Type:Organization
Organization Name:MATTHEW R. GAGE, D.C.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:R
Authorized Official - Last Name:GAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-788-3713
Mailing Address - Street 1:1701 E MADISON AVE
Mailing Address - Street 2:STE A
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-3000
Mailing Address - Country:US
Mailing Address - Phone:316-788-3713
Mailing Address - Fax:316-788-3231
Practice Address - Street 1:1701 E MADISON AVE
Practice Address - Street 2:STE A
Practice Address - City:DERBY
Practice Address - State:KS
Practice Address - Zip Code:67037-3000
Practice Address - Country:US
Practice Address - Phone:316-788-3713
Practice Address - Fax:316-788-3231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-033389111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS062064OtherBLUE CROSS BLUE SHIELD
KS8196OtherPREFERRED HEALTH SYSTEMS
KS007277OtherBLUE CROSS BLUE SHIELD
KSN612OtherPREFERRED HEALTH SYSTEMS
KS007277OtherBLUE CROSS BLUE SHIELD
KS062064Medicare ID - Type Unspecified
KST43939Medicare UPIN
KSU99802Medicare UPIN