Provider Demographics
NPI:1457434367
Name:SAMS, MATTHEW DUANE (DC)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DUANE
Last Name:SAMS
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 1:225 VIOLYN DR
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-8128
Mailing Address - Country:US
Mailing Address - Phone:417-334-6660
Mailing Address - Fax:417-334-6661
Practice Address - Street 1:225 VIOLYN DR
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-8128
Practice Address - Country:US
Practice Address - Phone:417-334-6660
Practice Address - Fax:417-334-6661
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006810111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO128937OtherBLUE CROSS BLUE SHIELD
MO230074281Medicaid
MO350056657OtherRAILROAD MEDICARE
MO350056657OtherRAILROAD MEDICARE