Provider Demographics
NPI:1336489335
Name:MATHON, ERIK (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIK
Middle Name:
Last Name:MATHON
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 1:20 LOWER VIA CASITAS APT 9
Mailing Address - Street 2:
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2230
Mailing Address - Country:US
Mailing Address - Phone:415-302-7887
Mailing Address - Fax:
Practice Address - Street 1:240 MILLER AVE STE D2
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2858
Practice Address - Country:US
Practice Address - Phone:415-302-7887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYDC026571111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor