MEDICARE: DR. MICHAEL PHILIP MATHES D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	0104001892	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	171936	OTHER	VA	BC/BS
2	C06302	OTHER	VA	BC/BS GROUP #

General Provider Information

NPI Number	:	1861588733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL PHILIP MATHES D.C.

Provider Business Mailing Address
First Line	:	9129 DICKEY DR
Second Line	:
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23116-2502
Country	:	US
Telephone Number	:	804-746-5700
Fax Number	:	804-746-0500

Provider Business Practice Location Address
First Line	:	9129 DICKEY DR
Second Line	:
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23116-2502
Country	:	US
Telephone Number	:	804-746-5700
Fax Number	:	804-746-0500

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	01/16/2023

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Directions to “ DR. MICHAEL PHILIP MATHES D.C.” Practice Location

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