Provider Demographics
NPI:1205138831
Name:LAROSH, MATTHEW DUDLEY (DC,)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DUDLEY
Last Name:LAROSH
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 1:4525 SW 21ST ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-3505
Mailing Address - Country:US
Mailing Address - Phone:785-272-4242
Mailing Address - Fax:785-272-5623
Practice Address - Street 1:4525 SW 21ST ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-3505
Practice Address - Country:US
Practice Address - Phone:785-272-4242
Practice Address - Fax:785-272-5623
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-02
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05301111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor