Provider Demographics
NPI:1295742690
Name:HALES, MATTHEW D (DC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:D
Last Name:HALES
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 1:1640 W CHERRY LN STE 130
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1321
Mailing Address - Country:US
Mailing Address - Phone:208-895-8595
Mailing Address - Fax:208-884-1835
Practice Address - Street 1:1640 W CHERRY LN STE 130
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-1321
Practice Address - Country:US
Practice Address - Phone:208-895-8595
Practice Address - Fax:208-884-1835
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1153111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor