Provider Demographics
NPI:1629382528
Name:MATTHEWS CHIROPRACTIC & SPORTS REHABILITATION
Entity Type:Organization
Organization Name:MATTHEWS CHIROPRACTIC & SPORTS REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:856-596-6474
Mailing Address - Street 1:2001 LINCOLN DR W
Mailing Address - Street 2:SUITE B
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-1531
Mailing Address - Country:US
Mailing Address - Phone:856-596-6474
Mailing Address - Fax:
Practice Address - Street 1:2001 LINCOLN DR W
Practice Address - Street 2:SUITE B
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-1531
Practice Address - Country:US
Practice Address - Phone:856-596-6474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-03
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00671100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty