Provider Demographics
NPI:1134392509
Name:DR. MATTHEW ISNER, DC, PLLC
Entity type:Organization
Organization Name:DR. MATTHEW ISNER, DC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:OWEN
Authorized Official - Last Name:ISNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:304-532-7100
Mailing Address - Street 1:1510 ELIZABETH PIKE
Mailing Address - Street 2:
Mailing Address - City:MINERAL WELLS
Mailing Address - State:WV
Mailing Address - Zip Code:26150-8413
Mailing Address - Country:US
Mailing Address - Phone:304-489-1700
Mailing Address - Fax:304-489-1880
Practice Address - Street 1:1510 ELIZABETH PIKE
Practice Address - Street 2:
Practice Address - City:MINERAL WELLS
Practice Address - State:WV
Practice Address - Zip Code:26150-8413
Practice Address - Country:US
Practice Address - Phone:304-489-1700
Practice Address - Fax:304-489-1880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV868111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty