Provider Demographics
NPI:1861629198
Name:MATANZA, MARC NELSON (DC)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:NELSON
Last Name:MATANZA
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 1:711 E 16TH ST
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-4627
Mailing Address - Country:US
Mailing Address - Phone:619-474-3400
Mailing Address - Fax:619-474-3401
Practice Address - Street 1:711 E 16TH ST
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-4627
Practice Address - Country:US
Practice Address - Phone:619-474-3400
Practice Address - Fax:619-474-3401
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-12
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-31194111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor