Provider Demographics
NPI:1922144526
Name:MATHES FAMILY CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:MATHES FAMILY CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:MATHES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:804-746-5700
Mailing Address - Street 1:9129 DICKEY DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-2502
Mailing Address - Country:US
Mailing Address - Phone:804-746-5700
Mailing Address - Fax:
Practice Address - Street 1:9129 DICKEY DR
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-2502
Practice Address - Country:US
Practice Address - Phone:804-746-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001892111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA171935OtherBC BS GROUP NUMBER
VA=========Medicare UPIN
VA171935OtherBC BS GROUP NUMBER