Provider Demographics
NPI:1891850525
Name:BYSTROM, JOHN MATTHEW (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MATTHEW
Last Name:BYSTROM
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 1:1933 COFFEE RD
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-2704
Mailing Address - Country:US
Mailing Address - Phone:209-380-7975
Mailing Address - Fax:209-838-7753
Practice Address - Street 1:1933 COFFEE RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2704
Practice Address - Country:US
Practice Address - Phone:209-838-3434
Practice Address - Fax:209-838-7753
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30236111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor