Provider Demographics
NPI:1922147842
Name:HORN, MATTHEW P (DC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:P
Last Name:HORN
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 1:2158 E STATE RD
Mailing Address - Street 2:
Mailing Address - City:PORT CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:43452-2527
Mailing Address - Country:US
Mailing Address - Phone:419-732-6600
Mailing Address - Fax:419-732-6601
Practice Address - Street 1:2158 E STATE RD
Practice Address - Street 2:
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-2527
Practice Address - Country:US
Practice Address - Phone:419-732-6600
Practice Address - Fax:419-732-6601
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3604111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH20-2991920-00OtherSHEAKLEY UNICOMP
OH202991920-00OtherGATESMCDONALD
OH7398618OtherAETNA
OH2561562Medicaid
OH000000378723OtherANTHEM BCBS
OH20-2991920-00OtherSHEAKLEY UNICOMP