Provider Demographics
NPI:1720014541
Name:VAN MATRE, RYAN K (DC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:K
Last Name:VAN MATRE
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 1:718 ADAMS ST
Mailing Address - Street 2:STE D
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-7594
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:315 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DELPHI
Practice Address - State:IN
Practice Address - Zip Code:46923-1437
Practice Address - Country:US
Practice Address - Phone:765-564-1900
Practice Address - Fax:317-817-9903
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001984A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
193930Medicare PIN
INU79869Medicare UPIN