Provider Demographics
NPI:1013486224
Name:WHEELER, MATTHAN (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHAN
Middle Name:
Last Name:WHEELER
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 1:3904 E MULLAN AVE STE C
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-4009
Mailing Address - Country:US
Mailing Address - Phone:208-981-0093
Mailing Address - Fax:
Practice Address - Street 1:3904 E MULLAN AVE STE C
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-4009
Practice Address - Country:US
Practice Address - Phone:208-981-0093
Practice Address - Fax:208-981-0125
Is Sole Proprietor?:No
Enumeration Date:2018-11-16
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor