Provider Demographics
NPI:1376098285
Name:MATTES, GEORGE RYAN (DC)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:RYAN
Last Name:MATTES
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 1:643 SW LAKE CHARLES CIR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-3428
Mailing Address - Country:US
Mailing Address - Phone:772-559-9141
Mailing Address - Fax:
Practice Address - Street 1:1551 FORUM PL STE 500C
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2309
Practice Address - Country:US
Practice Address - Phone:561-422-1819
Practice Address - Fax:561-422-1819
Is Sole Proprietor?:No
Enumeration Date:2016-08-20
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11930111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor