Provider Demographics
NPI:1629057112
Name:BETTERTON, MATTHEW JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JOHN
Last Name:BETTERTON
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 1:1307 W 13TH ST
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52349-1400
Mailing Address - Country:US
Mailing Address - Phone:319-472-5151
Mailing Address - Fax:877-300-8998
Practice Address - Street 1:1307 W 13TH ST
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:IA
Practice Address - Zip Code:52349-1400
Practice Address - Country:US
Practice Address - Phone:319-472-5151
Practice Address - Fax:877-300-8998
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06409111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IADC8557OtherRAILROAD MEDICARE
IA25853OtherBLUE CROSS BLUE SHIELD
IA1228155Medicaid
IAU84211Medicare UPIN
IAI14578Medicare PIN