MEDICARE: MATTHEW P. HORN 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	3604	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20-2991920-00	OTHER	OH	SHEAKLEY UNICOMP
2	202991920-00	OTHER	OH	GATESMCDONALD
3	7398618	OTHER	OH	AETNA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	000000378723	OTHER	OH	ANTHEM BCBS

General Provider Information

NPI Number	:	1922147842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW P. HORN D.C.

Provider Business Mailing Address
First Line	:	2158 E STATE RD
Second Line	:
City	:	PORT CLINTON
State	:	OH
Zip	:	43452-2527
Country	:	US
Telephone Number	:	419-732-6600
Fax Number	:	419-732-6601

Provider Business Practice Location Address
First Line	:	2158 E STATE RD
Second Line	:
City	:	PORT CLINTON
State	:	OH
Zip	:	43452-2527
Country	:	US
Telephone Number	:	419-732-6600
Fax Number	:	419-732-6601

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

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	03/24/2016

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