Provider Demographics
NPI:1700886561
Name:LYTLE, MATTHEW B (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:B
Last Name:LYTLE
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 1:3452 MCKELVEY RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2533
Mailing Address - Country:US
Mailing Address - Phone:314-739-8841
Mailing Address - Fax:314-739-6043
Practice Address - Street 1:3452 MCKELVEY RD
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2533
Practice Address - Country:US
Practice Address - Phone:314-739-8841
Practice Address - Fax:314-739-6043
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005000287111N00000X
NE1379111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor