Healthcare Provider Details

I. General information

NPI: 1487787297
Provider Name (Legal Business Name): GREGORY S MATHENY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 10/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38650 SUSSEX HWY UNIT 9
DELMAR DE
19940-3527
US

IV. Provider business mailing address

14738 ARVEY RD
LAUREL DE
19956-3068
US

V. Phone/Fax

Practice location:
  • Phone: 302-846-3244
  • Fax: 302-846-3255
Mailing address:
  • Phone: 302-875-7202
  • Fax: 302-846-3255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberF1-0000644
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: