Provider Demographics
NPI:1942565064
Name:DRAKE, MATTHEW R (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:R
Last Name:DRAKE
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 1:1106 N 155TH ST
Mailing Address - Street 2:STE C
Mailing Address - City:BASEHOR
Mailing Address - State:KS
Mailing Address - Zip Code:66007-7100
Mailing Address - Country:US
Mailing Address - Phone:913-708-0867
Mailing Address - Fax:
Practice Address - Street 1:22575 TONGANOXIE RD
Practice Address - Street 2:
Practice Address - City:TONGANOXIE
Practice Address - State:KS
Practice Address - Zip Code:66086-4229
Practice Address - Country:US
Practice Address - Phone:913-708-0867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-05
Last Update Date:2017-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0105479111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor