Provider Demographics
NPI:1881366631
Name:JOHNSON, MATTHEW KYLE
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:KYLE
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 LONG HOLLOW PIKE STE 205
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-1853
Mailing Address - Country:US
Mailing Address - Phone:319-499-8089
Mailing Address - Fax:
Practice Address - Street 1:529 N MARKET ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405-3912
Practice Address - Country:US
Practice Address - Phone:423-265-2225
Practice Address - Fax:423-265-3111
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-30
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000003342111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor