Provider Demographics
NPI:1255442521
Name:GOLTL, MATTHEW E (DC)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:E
Last Name:GOLTL
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 1:800 E 1ST ST N
Mailing Address - Street 2:SUITE 350
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-2787
Mailing Address - Country:US
Mailing Address - Phone:316-262-6665
Mailing Address - Fax:316-262-6649
Practice Address - Street 1:800 E 1ST ST N
Practice Address - Street 2:SUITE 350
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-2787
Practice Address - Country:US
Practice Address - Phone:316-262-6665
Practice Address - Fax:316-262-6649
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS104220111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor