Provider Demographics
NPI:1881703015
Name:MATNEY, LARRY J (DC)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:J
Last Name:MATNEY
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 1:1501 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:KS
Mailing Address - Zip Code:66067-3802
Mailing Address - Country:US
Mailing Address - Phone:785-242-4100
Mailing Address - Fax:785-242-4121
Practice Address - Street 1:1501 S MAIN ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:KS
Practice Address - Zip Code:66067-3802
Practice Address - Country:US
Practice Address - Phone:785-242-4100
Practice Address - Fax:785-242-4121
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-03054111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS4657100OtherAETNA
KS481174803OtherTAX IDENTIFICATION
KS014270Medicare ID - Type Unspecified
KS4657100OtherAETNA