Provider Demographics
NPI:1770825895
Name:DEMATTE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:DEMATTE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEMATTE
Authorized Official - Suffix:IV
Authorized Official - Credentials:DC
Authorized Official - Phone:610-377-1900
Mailing Address - Street 1:1155 INTERCHANGE RD
Mailing Address - Street 2:
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235-9068
Mailing Address - Country:US
Mailing Address - Phone:610-377-1900
Mailing Address - Fax:610-377-1516
Practice Address - Street 1:1155 INTERCHANGE RD
Practice Address - Street 2:
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-9068
Practice Address - Country:US
Practice Address - Phone:610-377-1900
Practice Address - Fax:610-377-1516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-006559L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty