Provider Demographics
NPI:1609898048
Name:METCALF, MATTHEW ROBERT (DC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ROBERT
Last Name:METCALF
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 1:22669 BEDFORD RD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:KS
Mailing Address - Zip Code:66083-5534
Mailing Address - Country:US
Mailing Address - Phone:913-226-1463
Mailing Address - Fax:913-592-3542
Practice Address - Street 1:22386 S HARRISON ST
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:KS
Practice Address - Zip Code:66083-3148
Practice Address - Country:US
Practice Address - Phone:913-592-3541
Practice Address - Fax:913-592-3542
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04727111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS060830Medicare UPIN
KS060830Medicare ID - Type Unspecified