Provider Demographics
NPI:1972964385
Name:BRYCE MATTHEWS, D.C., CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:BRYCE MATTHEWS, D.C., CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:760-846-6877
Mailing Address - Street 1:4835 VAN NUYS BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-2109
Mailing Address - Country:US
Mailing Address - Phone:818-786-5985
Mailing Address - Fax:818-786-6849
Practice Address - Street 1:4835 VAN NUYS BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-2109
Practice Address - Country:US
Practice Address - Phone:818-786-5985
Practice Address - Fax:818-786-6849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-11
Last Update Date:2016-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty