Provider Demographics
NPI:1801072947
Name:MULLINS, MATTHEW PETER (DC)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:PETER
Last Name:MULLINS
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 1:245 BLOOMFIELD DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-7788
Mailing Address - Country:US
Mailing Address - Phone:717-569-5075
Mailing Address - Fax:717-569-5030
Practice Address - Street 1:245 BLOOMFIELD DR
Practice Address - Street 2:SUITE 201
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-7788
Practice Address - Country:US
Practice Address - Phone:717-569-5075
Practice Address - Fax:717-569-5030
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-19
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008857111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA264884OtherHEALTHASSURANCE
PA3741100OtherAETNA
PA001471947OtherHIGHMARK
PA1471947OtherPERSONAL CHOICE
PA264884OtherHEALTHASSURANCE
PA001471947OtherHIGHMARK
PAU94635Medicare UPIN